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
(Note: This information concerns those who are on Individual & Family health plans. It does not concern you if you are on Medicare or an Employer or Employee on a Group-sponsored or Government-sponsored health plan. This information pertains only to California and does not apply to other states.)
This is a reminder that if you are currently on an Anthem Blue Cross Individual or Family (IFP) health plan (not Medicare or Group plan), and you received a notice from Anthem that your health plan will not be renewed on Jan. 1, then you need to take action by Dec. 15.
On Jan. 1, Anthem will be withdrawing IFP plans from all regions in California EXCEPT for 3. Those 3 regions and the affected counties are listed below. These include 22 sparsely populated counties in N. Calif., Santa Clara county and 5 counties in the Central Valley.
The IFP plans that are affected include plans within the Covered CA Exchange (On-Exchange), as well as plans outside the Covered CA Exchange (Off-Exchange). They include Subsidized plans as well as Non-Subsidized health plans. Those who are on Grandfathered IFP plans are not affected.
If you need help securing a plan from an alternate insurance carrier such as Blue Shield, Health Net or Kaiser, please contact me at [email protected] or call 925-284-2000 Ext. 101.
Anthem Blue Cross IFP Plans will be discontinued on Jan. 1 from all CA Counties EXCEPT the following:
Sincerely,
Phil Lee Lee Health Insurance Services
925-284-2000 Ext. 101
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:
(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
Employee Benefits & Health Insurance
]]>I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:
Please review the following to be sure that you will actually be affected by this:
We might be able to help you find alternatives as soon as the insurance carriers such as Blue Shield, Health Net and Kaiser release their new rates for Jan. 1, in either September or October.
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
]]>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
925-284-2000
]]>SB 562 is very bad for you, your family and the future of the State of California for many reasons:
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.
]]>As a courtesy, we are passing this information onto you.
|
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)
925-284-2000
]]>