What can be done about it now?

There are five scenarios in which Medicare Advantage members may disenroll from their plan.

Scenario #1
If you are disenrolled from an MA plan because the plan is leaving Medicare, stops giving care in their area, or the customer moves out of the plan’s service area, you are eligible to change. Customers in this scenario are guaranteed issue of a Medicare Supplement plan A, B, C, F, HDF, K, or L that are sold in their state by any insurer.

Customers can apply for a Medicare Supplement as early as the day they receive notice that their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #2
You joined an MA Plan when you were first eligible for Medicare Part A at age 65, and within the first year of joining you may exercise your right to switch to Original Medicare. Customers in this scenario are guaranteed issue of any Medicare Supplement plan sold in their state by any insurer. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #3
Or … you dropped a traditional Medicare Supplement to join Medicare Advantage for the first time, less than a year ago and you wish to switch back to Original Medicare. Customers in this scenario are guaranteed issue of the Medicare Supplement policy they had before they joined MA if the same insurance company they had before still sells it. If the former Medicare Supplement policy isn’t available, they can buy a Medicare Supplement plan A, B, C, F, HDF, K, or L sold in their state by any insurance company. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #4
You have been with an Medicare Advantage plan for more than one year and are considering dis-enrolling and returning to original Medicare, and then purchasing a Medicare Supplement.

In most cases, an MA enrollee must stay enrolled for that calendar year starting the date their overage begins. According to Medicare, a customer who has been with an MA plan for more than one year may disenroll if Medicare has made a determination that a Medicare Advantage organization materially misrepresented plan provisions or violated its agreement with the enrollee. Customers in this scenario are guaranteed issue of Medicare Supplements A, B, C, F, HDF, K, and L that is sold in their state by any insurance company. [This one is tough to do].

Scenario #5
If you dis-enroll from Medicare Advantage, having been on Medicare Advantage MORE THAN one year and are not in Scenario 4, you are NOT guaranteed issue. This simply means that your application will be medically underwritten. You may or may not qualify, but this is something I will likely be able to tell you at the time of application.

I have been helping people with Medicare Supplements since the early 1980′s. In almost all cases, I prefer my clients to be with original Medicare and purchase a Medicare Supplement. I believe that, in the long run, this is the most cost effective decision. It certainly is the decision with the most stability.

Call me anytime if you have questions, or if I can assist you in any way.

Michael

With recent rate hikes on individual and group insurance plans, many experts are recommending that consumers shop around as many commonly do with auto insurance. For instance, California Insurance Commissioner Steve Poizner, in a recent statement said,

“As a consumer you need to shop around. A different provider may prove to be a better value for a particular individual or family’s needs, and all of them are looking for new customers. I encourage consumers who are not happy with their rates, co-pays, benefits or service to look at other options.”, says Poizner.

Honest, consumer based evaluation of health plans and carriers are really the need of the hour. We think that this is the role that the insurance intermediary should volunteer to take up. In fact, this is exactly what we have been doing for some time now.

Most people find insurance confusing. I am here to help. My only preference in insurers is the one that will fill your need and circumstances best. This is why I offer the selection of companies I offer.

Whether the need is group insurance, individual/family plans or Senior health plans (Medigap), I save people money with my “Solutions That Work”.

So if you do not have insurance and need it, or if you have it and think it’s too high, call me. I can help.

Call me at 209-390-1163 or 866-301-9652.

Michael Myers

Although not actually correct, I am going to include the so-called “Medicare Advantage” plans in this discussion.

Technically, Medicare Advantage Plans (Plan C) is not a Medicare Supplement – it is a Medicare and Medicare Supplement alternative. But you only care about what is the best choice, so I will be referring to them in this post.

Medicare Advantage Plans were often viewed as the best choice by many – if for no other reason, some were zero cost (other than the Medicare Part B premium). It is my opinion that these are going to get less available each year, and except in rare situations, I am not a fan of Medicare Advantage plans. I would prefer my clients have something that is not likely to change at all … whereas Medicare Advantage plans, by their very design change every year! (And sometimes they get withdrawn in the middle of the year). I think people should be shown the dignity of allowing them to plan – and live their plan. I don’t think it respectful to constantly be forcing change. I therefore am not a fan of those plans.

Of the Medicare Supplements on the market, I still prefer Plan “F”. With Plan “F” and original Medicare, all normal medical expenses are generally covered in full. I think it good that a person can plan for their health insurance needs and know what they are going to be. I have had clients on “Plan F” plans for over 15 years – and they would not change for anything!

A good second choice is Plan “N” – one of the new plans. This plan works much like a group health plan that a person may be accustomed to. The premium on this plan is less than a Plan “F”, however, you do have co-pays and share of costs to consider. In my opinion – Plan “F” is the better choice over the long haul – but Plan “N” is a reasonable second choice if a person desires to save monthly premium.

No matter which insurance company you purchase these plans from, if they have the same letter designation, they are the same plan. Which company is best? By “best”, I find most people mean “lowest premium”. Assuming that the company handles claims properly. I too will use premium as one of the benchmarks I use to decide which company I feel is “best”.

To answer which company is “best”, several factors must be considered. Your home zip code, your date of birth and whether you are male or female.

I can help you find the “best” company. Just call and ask me. I can be reached at 209-390-1163. I am looking forward to talking to you.

Over the thirty years or so I have been working in sales, I have seen sales gurus come and go. Their advice sometimes has merit, sometimes it simply does not. Some are genuinely interested in helping others in sales learn what it is people want and need. Others just like the sound of their own voice.

One of the worse pieces of self-proclaimed wisdom is the strong idea that a sales person should never become “an unpaid consultant”.

I could not disagree more. Here is why:

Product – no matter what it is – insurance, financial services, legal aid, plumbing, carpentry … well, you get the idea, no matter what it is – it’s just a commodity.

Customers form their strongest relationships with people who give the most value. In today’s selling environment, what you sell — be it a product or service — is, in itself, the least valuable thing that you offer. In fact, it is probably viewed by most buyers as a commodity
But good advice is something people do not get from very many people. Good advice trumps whatever the product is by a 1,000 percent!

So ask me any question about insurance. I am here to help, even if I don’t have something that will be useful to you. The worst case scenario is I will point you in the right direction. And if I can help you, I will give you the choices you need to make a good decision you will be happy with for a long time.

Sometimes people will continue working primarily due to feeling the need for health insurance. This is understandable, in view of the uncertainty today.

When a person does reach Medicare age, questions often arise. Questions like:

1) What is original Medicare?

2) What are Medicare Advantage Plans?

3) What about prescription drugs? And finally …

4) What about Long Term Care?

Original Medicare is broken into two parts, Part A (Hospital) and Part B (Doctors and other things). Part “A” comes with Social Security and you do not pay for it. Part “B” you do pay for, as it is subtracted from your Social Security Check. Some people qualify for help with this premium, while others pay more (due to large incomes). Most people pay $96.50 for Part “B”. Some people elect not to enroll in this, but I believe that almost everyone should enroll in Part “B”. It is the best deal in health care today.

Medicare Supplement Plans (sometimes called MediGap policies), pay on the deductibles and co-pays that Medicare does not pay. They only pay on expenses that are “covered” by Medicare. In other words: if Medicare pays something for the service, then MediGap policies have a benefit. Conversely, if Medicare does not cover the expense at all, then neither does any MediGap policies.

Medicare Supplement polices are standardized. Each policy has a letter designation, and every company who sells that “letter designation’ has the same policy. So a “Plan F” from company XYZ is the same policy and has the same benefits as a “Plan F” from company ABC. The only difference is the premium and how well a company serves your needs.

I am a big advocate of original Medicare combined with a good supplement. In my view, and in most cases, a person will have the lowest overall medical expenses choosing this option. (Ask me and I will help you decide if this would be true for you). But the best part is a person’s medical expenses are predictable using this option.

You are allowed to enroll without health questions when you enroll in Part “B” of Medicare. The legal time frame is three months prior to three months after (a total of seven months). Some companies choose to allow more time. And some companies allow this at any time on some plans. And in CA, a person can change companies but keep the same plan in their birthday month without health questions.

Choosing Original Medicare with its Part “A” and Part “B” along with a MediGap policy is felt by many (including myself) to be best for people who wish to know exactly what their health costs will be or for those who travel a lot.

Medicare Advantage Plans are also known as Medicare Part “C”. It is essentially the privatization of Medicare. A person still pays for Part “B”, but could pay anywhere from Zero dollars to around a hundred dollars per month for the plan. It is different in each County. Although it is Medicare, these plans work a little more like a person may be use to coming off a group health plan. Typically, you will have co-pays and the like, with a maximum out of pocket. You do not know what your total costs will be, but you do know the maximum it could be (which is typically considerably higher than staying with Original Medicare and a supplement). These plans differ somewhat in that a doctor may choose to accept it or not, and may in fact, choose to accept you this week, but not next week. He may choose to accept your best friend, but not accept you. A physician cannot do this with original Medicare, but it is legal for him to do this with Medicare Advantage Plans. They refer to it as “deeming”. A decision to accept you does not establish a policy, but rather a decision made on each visit. Just so you know, it is not common for Physicians to do this, but it can and does happen for reasons beyond anything you have control over.

Medicare Advantage Plans operate under very strict enrollment procedures, but a person needs to know that each year, for the last six weeks of the year, a person can change their plan, or return to Original Medicare, if they choose. There are other times, under various rules that allow changes. Ask me for it, and I will give you the complete rules regarding this.

The important thing to understand is that a person does not give up Medicare when enrolling in one of these plans. However, there are rules that must be followed and it is in a person’s best interest to review this each year, as under current CMS (Center for Medicare and Medicaid Services) rules, the plans may change each year. I cannot stress enough the need to do this if a person chooses a Medicare Advantage Plan. The changes can be drastic.

Medicare Advantage Plans, in my view, are not a good option. However, there are exceptions to this statement. If appropriate, they are usually best for people; 1) who wish to keep premiums low, 2) do not mind taking a risk on the total potential out of pocket, and 3) do not travel a lot.  Some counties still have zero premium plans available, which covers a person as well as they may be use to under their group insurance plan (of course, each plan is different and a comparison should be made).

Prescription Drugs are covered under Medicare Part “D”. These plans are typically sold nationally (as opposed to by County). They can be included in Medicare Advantage Plans or purchases separately. It takes quite a lot to explain these, but suffice it to say that there are quite a few differences between plans. The design of these plans came out of Congress, and I cannot explain the rationale behind the design, as I find the design illogical. However, I can show you, not only a good plan for you, but also how to utilize the plan to best serve your interests which means, to save you money.

Long Term Care is really a separate subject. Although Medicare does have a Limited Benefit for Skilled Nursing, the two operative words are “Limited” and “Skilled”. It is good for short stays while a person is recovering and making progress. Basically, it is for those instances where a person is not sick enough to be in the hospital, but still needs some care while recovering. It is not for long-term convalescent care. This type of coverage can be handled in a lot of different ways, and which way is best for an individual will depend on their financial situation, married or not, and a host of other factors. The only constant is planning is needed. The decision cannot be made at the time of need, or at least not made well.

There are 636,000 Medicare Advantage Plan Seniors that are being cancelled. About half of those enrolled in Medicare Advantage plans in my county are being impacted by this.

Now its true that some will find other plans to select from. But its important to understand that of the approximately 9,500,000 seniors still covered by Medicare Advantage Plans; many of these seniors are facing reduced benefits as many Medicare Advantage carriers are LOWERING BENEFITS TO SENIORS!
 
Simply stated, over 10,000,000 seniors are being impacted by the decisions being made in Washington.
 
I saw much of this coming, and this is why I have for a very long time advocated that Seniors – in most cases – are far better served by staying with Original Medicare and purchasing a separate, stand-alone, Part D (prescription) plan.

With the right Medicare Supplement, many, if not most, people – even after paying premiums – will have less out of pocket on health care costs.

For those impacted by this, (with a copy of their disenrollment letter), Medicare Supplements will be Guaranteed Issued with no waiting periods for any pre-existing health conditions. Everyone qualifies!

But even if this is not the case, let me help you decide what product serves you the best. I am here to help. Call me (209-390-1163) or email me today.

A recent experience got me to thinking…

Our local grocery store is owned and managed by a nice family. The family has been in the community for over 100 years. Apparently they rely a great deal on their delivery people to “decide” what they will carry in their grocery store. I do not know why they choose to do this, but, convenience aside … I think they make a mistake by allowing others to decide what products they will carry.

Why do I say this?

Here’s an example:  My family enjoys a particular brand of Chocolate Chip ice cream.  Apparently we are not the only ones, as it is usually the first flavor to sell out at the local market.  Now, the way I see it – “supply and demand” dictates that if a product “sells out” consistently – you might want to stock more of it and less of some other flavor that doesn’t sell as well.

Not at our local market.  At our local market when the demand increased for this particular item – the ice cream delivery person simply stopped stocking it. This makes his job easier I guess.  So now, when he delivers his stock, there is not as much he needs to unload.  I can only surmise that the delivery man must be a simple wage-earner.

Now I assume my local market earns money on each item sold. But I have noticed that they follow this same logic with other popular items they sell.  If it sells well, evidently in order to not have to stock quite so often, they just don’t carry it any more.   I guess your store shelves remain filled this way, you require less personnel for stocking, and the quiet, easy going manner in which you’ve always operated remains uninterrupted.  More time for fishing that way.

Here at mpmyers.com – we do not reason this way. We are here to serve you, our client. This means we are willing to work for you.  We sell you – not what is easiest for us – rather what our clients want and we work very hard to obtain exactly what you need. We take that very seriously, and we have for 30 years.

Next time you have an insurance need – call me. If I don’t have it, or can’t get it, I will likely be able to direct you someplace where you can get it. I won’t try to sell you Rocky Road – when what you want is Chocolate Chip.

For years, those of us in the insurance business who sought to put our clients first called ourselves “Brokers”. Now the term Broker is really a misnomer, for we are in fact – from a legal standpoint Agents.

With that thought in mind – call me an Agent of Change. Changes are coming, there is no stopping them. My job is to guide and advise you in how these things impact you.

Whether it be in the medical insurance field (under or over 65), employee benefits (or outsourcing employees), planning for long term care, or using old products such as life insurance in new and better ways – to “bank on yourselves” (you have to see this illustrated to understand how different and better this concept is over the old ways of doing things) – call me. I am here to help you. I am an Agent of Change.

Michael Myers

Without being political, I cannot allow my readers to believe that what is being widely reported by the traditional news organizations is truthful. It is not. I have noted repeated misstatements and what I call endrounds (that is saying something that may be true in itself yet serves to obfuscate the listener).

The Health Proposal in Congress is long. Few if any know everything that is in the bill. However, a Duke Professor did an analysis on it and I thought it worth posting. He allows the language in the Bill to speak to the questions. No interpretations … just a reprint of what is in the Bill.

http://www.classicalideals.com/HR3200.htm

This in no way addresses all of the concerns people have about this issue, but it does a pretty good job addressing some of the false reporting going on by those who seemed to have forgot what the word “reporter” means.

There is a lot more to this, but my pupose here is to educate, not editorialize. But, if there is anything I can answer for you, please do call me or email me.

Michael Myers

There was a story in The Record yesterday, apparently picked up from the Wire Services (or so the editor told me), that made the statement that Medi-Cal is California’s version of Medicare. This is not correct, and since this is an ongoing point of confusion, I thought I would take a moment and explain.

Medicare is the government health care system, typically available to you at age 65. There are exceptions to this statement, such as a person may be able to qualify early in cases of disability or sometimes will not elect to go on it until a later age when they are still working. However, for purposes of keeping it simple, it’s the health insurance you get when you retire at age 65.

Medicaid is government health insurance for those of little means. It has many qualifications, but in all cases is income based.

Medi-Cal is California’s version of Medicaid, not Medicare.

I just wanted to clear that small error up.

And remember, if you have Medicare, I offer services that can help you determine what supplemental program may best meet your needs. Give me a call. I can help you.