It’s come to my attention that Kaiser Medicare Advantage HMO has raised its Annual Out of Pocket maximum to $6,700 starting on Jan. 1, 2018. This could be a financial burden for many seniors.

As an alternative, Medicare Supplement Plan F has $0 Out of Pocket costs for any Medicare-eligible medical expense (except for a separate Prescription Drug Plan), and allow access to any Medicare provider in the U.S.

For those turning 65 in Contra Costa, Anthem Blue Cross Medicare Supplement Plan F plan premiums can be as low as $115/month, after discounts. (This is compared to Kaiser Medicare Advantage’s monthly premium of $103/month, including Rx.)

If you have any questions, we’d be happy to consult with you on your options.

(The above is meant to be informational. This information has not been approved by CMS or any regulatory agency. This is not sales material and should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee
Lee Health Insurance Services 925-284-2000
www.Health-Insurance.com
Employee Benefits & Health Insurance

This is a reminder that we are in Open Enrollment season for several lines of health insurance plans.

(A) For Those Under Age 65 on Individual & Family Plans
• Annual Open Enrollment period (AEP) this year runs from Nov. 1 through Jan. 31.
• You may enroll into or change Covered CA On-Exchange (with subsidy) as well as Off-Exchange (no subsidy) plans.
• Competitive Rate Comparison Proposals for On Exchange as well as Off Exchange plans are now available for Jan. 1, 2018. Please let us know if you would like one prepared for you.
• On Jan. 1, Anthem Blue Cross will be terminating their Individual plans in most counties in California except for some in rural Northern California.
• If you received a cancellation notice from Anthem Blue Cross, please contact us for a proposal to show you alternative plans from Blue Shield, Health Net, Kaiser, etc.
• If you received a large rate increase, ask us for a proposal showing alternatives.

(B) For Those Seniors Over Age 65 on Medicare
• For those on Supplement plans, there is NO Open Enrollment Period. Your supplement plans do not require renewal and continue uninterrupted until you cancel it.
• For those on Supplement Plan F, CMS (Center for Medicare Medicaid Services) will prohibit new sales after Jan. 2020. But those who are already on Plan F at that time will be grandfathered indefinitely.
• For those wishing to switch from a Medicare Advantage HMO plan to a Supplement Plan, there is no Open Enrollment and no Guarantee-Issue (GI) unless you have a Qualifying Event (QE), such as a move from out of state. You will wish to review the 13 Guarantee-Issue (GI) situations in CA that you may possibly qualify for. Even if you don’t qualify, there is no penalty for applying and going through the non-GI underwriting (approval) process. Chances are good that you may still qualify based on your health. The process for this type of transition is tricky and the timing very tight. If you think you may want to do this, start this process early to give yourself enough time to receive approval. We recommend that you seek professional assistance from an experienced agent knowledgeable in this area.

(The above is meant to be informational. This information has not been approved by CMS or any regulatory agency. This is not sales material and should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee
Lee Health Insurance Services 925-284-2000
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
[email protected]
Employee Benefits & Health Insurance

Medicare Enrollment season is once again upon us.

The Medicare Open Enrollment Period for Medicare Advantage Plans (i.e. HMO, Part D PDP Rx plans) runs from Oct. 15 to Dec. 7.

There is no open enrollment period for Medicare Supplement plans which do not need to be renewed. They continue month to month until cancelled.

Here are some common questions that we have been asked:

1. When is the 2017-18 Medicare Annual Enrollment Period (AEP)? For most people, Medicare AEP runs from Oct. 15th to Dec. 7th. You may do the following during this time: 1. Enroll or change your Medicare Advantage plan (MA-PD). 2. Enroll or change your Medicare Rx (PDP) plan. 3. Enroll in a Medicare Supplement and a PDP plan (the supplement plan is not guarantee-issue unless you have a qualifying event). Technically, AEP only applies to Medicare Advantage plan.   These plans include Advantage MA-PD (Medicare Advantage-Prescription Drug, mostly HMO) plans as well as Advantage PDP (Prescription Drug Rx Plan) plans. These Advantage plans are regulated by CMS (the federal Center for Medicare & Medicaid Services, which is part of HHS, the federal Dept. of Health & Human Services). Medicare Supplement plans on the other hand, are regulated by the State’s Dept. of Insurance which does not have AEP’s and go by different rules.

(B) Can I Switch into a Medicare Supplement Plan from a Medicare Advantage HMO Plan during AEP? Supplement plans may be purchased anytime, as long as you have Original Medicare Parts A & B. However, if you have an Advantage MA-PD plan currently, you must either have a qualifying event or be subject to medical underwriting. For those who have a Qualifying Event (QE), e.g. their Advantage plan is terminating or moving out of their area at year end, they have until Dec. 31st to enroll into a Medicare Supplement and PDP plan for a Jan. 1st effective date. I recommend that you enroll no later than Dec. 15 because of the holidays as well as the crushing workload of the insurance carriers. For those without a QE, switching to a Supplement Plan is difficult and filled with pitfalls. This process should be started early in the Enrollment season (Oct. 15th), and handled very carefully with assistance from a knowledgeable Medicare insurance agent. It involves medical underwriting (approval based on health). There is no guarantee of approval by a Supplement carrier. And you must not enroll into a PDP plan before you have received approval from a Medicare Supplement carrier, otherwise your MA-PD plan may be cancelled, leaving you with no coverage except for Part A/B.

(C) Is Medicare Supplement Plan F going away? CMS (Center for Medicare Medicaid Services) has announced that they will ban the sale of Medicare Supplement F, the most popular supplement plan, after Jan. 2020.

Anyone who qualified for Plan F before Jan. 2010 will be grandfathered and permitted to keep the plan or enroll indefinitely. However, unless the enrollment is during the initial coverage enrollment period (ICEP), acceptance is not guaranteed. There may be medical underwriting. Those who will turn 65 or become eligible for Medicare after the year 2020 will unfortunately never be able to experience Plan F.
(D) **Are there any instances where one can enroll into Supplement F after Jan. 2020? We understand that anyone who was initially eligible for Plan F before Jan. 2020 would still be allowed to enroll into Plan F even if they enroll after that date.

(D) Are rates for frozen Supplement Plan F (after 2020) likely to skyrocket? Some concerns were raised that the premium for F plans may skyrocket, after 2020, due to there being no future new entrants into the risk pool. Although this is a distinct possibility, it is unlikely to be a cause for alarm for the following reasons: (1) Unlike under age 65 plans, supplement plans are secondary payers (Medicare is the primary payer) and not subject to the brunt of the risk, (2) In the past when older supplement plans were frozen, such as the Anthem Classic J plan, there were no great increases in rates, (3) After the freezing of Plan F, other plans like G and N will still be available. Although these other plans are not as comprehensive as F, (4) The Birthday rule allows members to switch to like, or downgrade plans, guarantee-issue, every year, on their birthday month, (5) Supplements plans are in a highly competitive marketplace. Currently there are over a dozen carriers in CA offering Plan F. This will likely keep prices competitive. The practical implication is that seniors may keep plan F and take a wait and see attitude. If rates go out of line at some point, then simply downgrade, guarantee-issue, on their next birthday.

(The above is meant to be informational. This information has not been approved by CMS. It is not to be used in sales. And should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee

Lee Health Insurance Services

925-284-2000

www.Health-Insurance.com

[email protected]

Employee Benefits & Health Insurance

The Senate Appropriations committee’s own budget analyst has estimated the cost to be $400 billion for just the first year, which is over twice the entire California State budget of $180 billion. SB 562’s sponsors have no clear plan for paying for single payer but have suggested new employer and employee taxes and income tax increases.  These taxes would be in addition to current Federal, State, local, municipal and property taxes that Californians pay.

Please see this press release from the California Association of Health Underwriters for more information.

https://bliscorp.egnyte.com/dl/6kk5OkKcvK

I was present in the Senate Chambers when this bill passed the Health Committee with a 5-2 party-line vote on April 26th. I was again present when the Appropriations Committee debated this bill on May 22nd.  But despite serious concerns raised by many of the committee members the bill passed with a 5-2 party-line vote.  It will now be voted on this week by the full Senate.

TO TAKE ACTION:

If you object to losing your right to Medicare, losing your employer plan, paying more taxes, losing your right to choose your doctor, your hospital and your insurance benefits please contact your State Senator to let him/her know. Click on the link below to find your State Senator and his/her contact information.  Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/

For your convenience, this is a letter template suitable for sending to your district Senator if you so choose:

https://bliscorp.egnyte.com/dl/9IOEU956MF

Phil Lee

www.health-insurance.com

925-284-2000

SB 562 is very bad for you, your family and the future of the State of California for many reasons:

• Single payer insurance will provide “one size fits all” insurance to all people living in California, including undocumented residents.  One plan will be offered to all Californians for cradle-to-grave health coverage.
• All Private Health Insurance will be prohibited.
• The plan benefits will be determined by an un-elected board of special interest appointees of the state government who will determine which benefits will be included and how much providers will be paid.  This will result in rationing health care and force doctors and hospitals to leave the state if they are not fairly compensated for their services.
• There will be no Medicare for Californians 65 and older. Seniors and the disabled who currently have Medicare, Advantage plans, Supplement plans and Part D plans will be dis-enrolled and enrolled on to the single payer plan.
• There will be no employer health insurance plans. Employers will no longer be able to attract the best employees in their fields because they cannot offer them benefits that are any better than the Single Payer plan.  If you work for a company that is located in many states, your employer will not be allowed to offer any plans in CA.
• There will be no Federal or State employee health insurance plans.
• There will be no union health insurance plans.
• There will be no Medi-Cal or Medicaid.
• All people living in California, whether legally or not, will have the same health plan.
• Doctors and hospitals will be paid for their services by the State of California, who will need to create a monstrous bureaucracy to process and pay claims.  Fraud, abuse and waste are a given.  Other government-run health plans such as Medicare, Medicaid and the Veterans Administration regularly suffer scandals in billing, payments and sub-standard care.
• State Senator Ricardo Lara, who is sponsoring SB 562, has not revealed how the state is going to pay for “free” health care for all.  Initial estimates are that the State of California would need an increase in current income tax of $350 billion for just the first year of the Single Payer plan. This amount equates to $9,200 for each man/woman/child in addition to what he or she is already paying in income tax.  A family of four would pay $37,000 more in income tax than they are currently paying.
• Sick people, low-income people and the undocumented from across the country would flock to California.  Healthy taxpayers would flee California.  The result would be long lines to wait for sub-standard health care with costly procedures such as heart and kidney transplants and life-saving drugs rationed or not included at all in the Single Payer plan.
• Senator Lara and his supporters have stated that California leads the rest of the country in innovative changes and now want to oppose Federal Government deliberations on changes to the health insurance market by being the first state to adopt the Single Payer system.  However, two other states, Colorado and Vermont, recently voted against Single Payer plans in their states due to the unrealistic tax burden it would put on its residents.

CALL TO ACTION:

If you object to losing your right to Medicare, losing your employer plan, being taxed an additional $9,200 per family member, losing your right to choose your doctor, your hospital and your insurance benefits, then please contact your State Senator to let him/her know.  Click on the link below to find your State Senator and his/her contact information.  Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/

Just say No On SB 562 to preserve your choice in health care and to keep California from declining into certain economic ruin.  Thank you for taking the time to read this email.

Here are some common questions that we have been asked:

(A) When is the 2016-17 Medicare Annual Enrollment Period (AEP)?
For most people, Medicare AEP runs from Oct. 15th to Dec. 7th.
You may do the following during this time:
1. Enroll or change your Medicare Advantage plan (MA-PD).
2. Enroll or change your Medicare Rx (PDP) plan.
3. Enroll in a Medicare Supplement and a PDP plan (the supplement plan is not guarantee-issue unless you have a qualifying event).
Technically, AEP only applies to Medicare Advantage plan. These plans include Advantage MA-PD (Medicare Advantage-Prescription Drug, mostly HMO) plans as well as Advantage PDP (Prescription Drug Rx Plan) plans. These Advantage plans are regulated by CMS (the federal Center for Medicare & Medicaid Services, which is part of HHS, the federal Dept. of Health & Human Services). Medicare Supplement plans on the other hand, are regulated by the State’s Dept. of Insurance which does not have AEP’s and go by different rules.

(B) Can I Switch into a Medicare Supplement Plan from a Medicare Advantage HMO Plan during AEP?
Supplement plans may be purchased anytime, as long as you have Original Medicare Parts A & B. However, if you have an Advantage MA-PD plan currently, you must either have a qualifying event or get your Original Medicare Parts A & B back from your Advantage plan, before you can be allowed into a Supplement plan.
For those who have a Qualifying Event (QE), e.g. their Advantage plan is terminating or moving out of their area at year end, they have until Dec. 31st to enroll into a Medicare Supplement and PDP plan for a Jan. 1st effective date. I recommend that you enroll no later than Dec. 15 because of the holidays as well as the crushing workload of the insurance carriers.
For those without a QE, switching to a Supplement Plan is difficult and filled with pitfalls. This process should be started early in the Enrollment season (Oct. 15th), and handled very carefully with assistance from a knowledgeable Medicare insurance agent. It involves medical underwriting (approval based on health). There is no guarantee of approval by a Supplement carrier. And you must not enroll into a PDP plan before you have received approval from a Medicare Supplement carrier, otherwise your MA-PD plan may be cancelled, leaving you with no coverage except for A/B.

(C) Is Medicare Supplement Plan F going away?
CMS (Center for Medicare Medicaid Services) has announced this year that they will outlaw the sale of Medicare Supplement F, the most popular supplement plan, after 2020.
Those who will turn 65 after the year 2020 will unfortunately never be able to experience Plan F.
However, anyone who is already on an F plan at that time will be grandfathered and permitted to keep it indefinitely. (**Please see (E) below.)

(D) Are rates for frozen Supplement Plan F (after 2020) likely to skyrocket?
Some concerns were raised that the premium for F plans may skyrocket, after 2020, due to there being no future new entrants into the risk pool. Although this is a distinct possibility, it is unlikely to be a cause for alarm for the following reasons: (1) Unlike under age 65 plans, supplement plans are secondary payers (Medicare is the primary payer) and not subject to the brunt of the risk, (2) In the past when older supplement plans were frozen, such as the Anthem Classic J plan, there were no great increases in rates, (3) After the freezing of Plan F, other plans like G and N will still be available. Although these other plans are not as comprehensive as F, (4) The Birthday rule allows members to switch to like, or downgrade plans, guarantee-issue, every year, on their birthday month.
The practical implication is that seniors may keep plan F and take a wait and see attitude. If rates go out of line, then simply downgrade, guarantee-issue, on their next birthday.

(E) **Are there any instances where one can enroll into Supplement F after Jan. 2020?
This information has not been confirmed or published by CMS, but we were told by a couple of insurance carriers that CMS rules will allow someone to enroll into Plan F after Jan. 2020, if they were initially eligible for F before Jan. 2020.

(The above is purely informational. This information has not been approved by CMS. It is not to be used in sales. And should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee
Lee Health Insurance Services
800-286-7445
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
[email protected]
Employee Benefits & Health Insurance

As reported by the San Francisco Business Journal, Blue Shield of California will be closed from September 3 to September 12 while its employees take the week of Labor Day off. Although Blue Shield announced there will be some customer service staff working that week we assume the phone lines will be jammed for the entire week.

It appears that Individual, Small Group and Medicare departments are affected by the shutdown.
We do not yet know whether the Blue Shield member portal, broker portal or employer portal will be accessible and will reflect current information during the shutdown.
ALL APPLICATIONS FOR BLUE SHIELD PLANS SHOULD BE SUBMITTED AS SOON AS POSSIBLE SO THEY CAN BE PROCESSED WITH AN ID NUMBER ISSUED BY FRIDAY, SEPTEMBER 2. APPLICATIONS ARE CURRENTLY TAKING 10-14 DAYS TO BE PROCESSED.
This is an unprecedented announcement by an insurance company. We will do our best to provide service to our clients during this shutdown, but if Blue Shield is closed our ability to provide customer service will also be severely impacted.

(NOTE: This information relates only to Blue Shield of California, a taxpaying non-profit insurance carrier that operates only in California. Please do not confuse this company with Anthem Blue Cross, or any other Blue Cross or Blue Shield organization in states outside of CA.)

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

We frequently hear stories about seniors who made this change hastily because they attended a meeting, or an agent came to their home.  Frequently these agents would represent a limited number, usually just one, Medicare Advantage HMO plan.  They typically do not give prospects an adequate overview or understanding of the entire universe of plans in the marketplace because they have limited knowledge and products to offer.   They don’t fully explain the consequences of your making such a switch.

If you are contemplating such a change, you should not do so lightly.  You should only do this after much thought and research.  It’s not a matter of simply changing plans or changing carriers.  It’s nothing short of changing  from one world of plans, Original Medicare with Medicare Supplement, to another entirely different world of plans, Medicare Advantage.

These are the issues you must consider:

1. This change may not be reversible in the future because Medicare Supplement plans are not guarantee-issue, except at age 65.  Supplement plans do not have an annual open enrollment period as Advantage plans do.   If you ever want to go back to Medicare Supplement from an Advantage plan, you will have to be medically underwritten and approved on your application before you will be enrolled.
2. 90% of our clients choose Medicare Supplement F plans because of the freedom to choose their own providers anywhere in the country, and also because of the freedom from Copays, Coinsurance and Deductibles for all medical costs, excluding Rx.  However over the years, many non-clients have approached us for help to make the difficult transition from Medicare Advantage, such as Kaiser back to Original Medicare and Supplement.  This process is not easy, and is full of tricky timing and health approval issues.
3. Medicare Advantage HMO plans like Kaiser Advantage or Scan Health require you to use only those doctors that are in their network.  You will not have the option to see any outside doctors such as from UCSF, Stanford, etc.  You will be required to obtain referrals and authorization for all specialists, procedures, etc.
4. Advantage plans do not include Foreign Travel benefits.
5. Kaiser Medicare Advantage does not cooperate with independent agents.  So we will not be able to service you on your Medicare plans at all.
6. CMS (Center for Medicare & Medicaid Services) has ruled that Medicare Supplement F plans can no longer be offered to new enrollees after the year 2020. If you think you might want a Medicare Supplement F plan in the future, you must enroll before 2020.
7. Medicare Trial Period and Medicare 24 Month Rule – Under very limited circumstances, Medicare beneficiaries who enroll in an Advantage plan at age 65 may have a 12 to 24 month Medicare Trial Period where they may switch back to Original Medicare, a Medicare Supplement plan and a Medicare PDP (Rx) plan, guarantee-issue.   But it must be done within 24 months from age 65 Medicare ICEP (Initial Coverage Enrollment Period).

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

Medicare Annual Enrollment Period (AEP) 2015

(A) When is the 2015 Medicare Annual Enrollment Period (AEP)?

Once again this year, Medicare AEP will run from Oct. 15th to Dec. 7th.

You may do the following during this time:

1. Enroll or change your Medicare Advantage plan (MA-PD).
2. Enroll or change your Medicare Rx (PDP) plan.
3. Enroll in a Medicare Supplement and PDP plan (the supplement is not guarantee-issue).

(B) Is Medicare Supplement Plan F going away?

Yes, CMS (Center for Medicare Medicaid Services) has announced this year that they will not allow Medicare Supplement Plan F, the most popular supplement plan, to be offered after year 2020.

However, anyone who is already on an F plan at that time will be grandfathered and permitted to keep it indefinitely.

In other words, if you think that you may ever want a Plan F, you must enroll by 2020. If you lapse your F plan before 2020, you will never be able to get it back again. Those who will turn 65 after the year 2020 will unfortunately never be able to experience the benefits of Plan F.

(C) Are rates for frozen Supplement Plan F likely to skyrocket?

Some concerns were raised that the premium for F plans may skyrocket, after 2020, due to there being no new future new entrants into the risk pool. Although this is a possibility, it is unlikely to be a cause for alarm for the following reasons: (1) Unlike under age 65 plans, supplement plans are secondary payers (Medicare is the primary payer) and not subject to the brunt of the risk. (2) In the past when older supplement plans were frozen, such as the Anthem Classic J plan, there was no great increase in rates. (3) After the freezing of Plan F, other plans like G and N will still be available, although these other plans are not as comprehensive as F. (4) Even if premiums should escalate, the Birthday rule allows members to switch to like, or downgrade, plans, guarantee-issue, every year, on their birthday month.

The practical implication is that seniors may keep Plan F and take a wait and see attitude. If rates go out of line, then simply downgrade, guarantee-issue, on their next birthday.

We would be delighted to help you find affordable solutions to your health care needs.

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

“Safeguarding your clients’ personal, financial and medical information is one of our top priorities, and because of that, we have state-of-the-art information security systems to protect your data. However, despite our efforts, Anthem was the target of a very sophisticated external, cyber attack. These attackers gained unauthorized access to Anthem’s information technology (IT) system and have obtained personal information from our current and former members such as their names, birthdays, member ID/Social Security numbers, street addresses, email addresses and employment information, including income data. Based on the information we know now, there is no evidence that banking, credit card, medical information (such as claims, test results, or diagnostic codes) were targeted or compromised.
Once the attack was discovered, Anthem immediately made every effort to close the security vulnerability, contacted the Federal Bureau of Investigation (FBI) and began fully cooperating with their investigation. Anthem has also retained Mandiant, one of the world’s leading cybersecurity firms, to evaluate our systems and identify solutions based on the evolving landscape.
Anthem’s own associates’ personal information – including our own – was accessed during this security breach. We join you in your concern and frustration, and we assure you that we are working around the clock to do everything we can to further secure your clients’ data.
Anthem will individually notify current and former members whose information has been accessed. We will provide credit monitoring and identity protection services free of charge so that those who have been affected can have peace of mind. We have created a dedicated website (www.AnthemFacts.com ) where members can access information such as frequently asked questions and answers. We have also established a dedicated toll-free number that both current and former members can call if they have questions related to this incident. That number is: 1-877-263-7995. As we learn more, we will continually update this website and share that information with you. And, we developed a memo template and FAQ to help you answer questions you may receive from your clients.
We want to personally apologize to you and your clients for what has happened, as we know you expect us to protect your information. We will do everything in our power to make our systems and security processes better and more secure, and hope that we can earn back your trust.”

Please note the toll free 877 number above and the website address www.AnthemFacts.com for more information.

The following Bloomberg article (link) sheds more light on the situation 24 hours after Anthem’s initial announcement and provides helpful steps to take to monitor your own information if you are an Anthem member :
http://www.bloomberg.com/news/articles/2015-02-05/what-to-do-right-now-if-you-re-one-of-the-80-million-anthem-members-who-got-hacked

If you are an Anthem member, I share your concerns and am sympathetic to your situation, as I and my family are also in the same position. I do not have any more information than what’s reported above. If you are affected, you will be receiving more communication from Anthem shortly.
Phil Lee
Philip W. Lee, MBA
Lee Health Insurance Services
800-286-7445
www.health-insurance.com