Medicare Supplement Plans | Lee Health Insurance Services

California Wants to Replace Your Health Plan with a Government-Run Single Payer Plan (SB 562)

April 26, 2017 By Phil Lee

The California State Senate is currently working on legislation to make a Single Payer System the only source of health care and health insurance in the state of California. The Bill is named SB 562 and it will be reviewed by the Senate Health Committee on Wednesday, April 26, at 1:30 PM in the Capitol building in Sacramento in Room 4203.

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.

Filed Under: Affordable Care Act, Covered California, Group Plans, Health Care Reform, Health Insurance, Individual/Family Plans, Medicare Plans Tagged With: ACA, Affordable Care Act, CA SB 562, CA Senate Bill 562, California Health Insurance, California Senate Bill 562, Covered California, Covered California Health Exchange, Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, Health Care Plans, Health Care Reform, health insurance, Health Insurance California, Health Plans California, Individual Health Insurance, Individual Health Plans, Individual Mandate, Medicare Advantage Plans, Medicare Part D Plans, Medicare PDP Plans, Medicare Plans, Medicare Supplement Plans, Ricardo Lara, SB 562, SB 562 Single Payer, Senate Bill 562, Senator Ricardo Lara, Single Payer, Single Payer Health Insurance

Medicare Annual Open Enrollment Period AEP 2016-2017

November 30, 2016 By Phil Lee

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or an Individual & Family Health Plan. This information pertains only to California and may or may not apply to other states.)

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

Filed Under: Medicare Plans Tagged With: AEP, Center for Medicare Medicaid Services, CMS, health insurance, Health Insurance California, Health Plans California, HHS, Medicare A and B, Medicare Advantage HMO, Medicare Advantage., Medicare F, Medicare Gap, Medicare Gap F Plan, Medicare Gap Plan F, Medicare MA-PD, Medicare PDP, Medicare Plans, Medicare Prescription Drug, Medicare Rx, Medicare Supplement, Medicare Supplement Plans, MediGap, Original Medicare

The Pitfalls of Leaving Original Medicare & Supplement Plan for Medicare Advantage HMO

October 27, 2015 By Phil Lee

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or on an Individual & Family Health Plan)

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:

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.
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.
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.
Advantage plans do not include Foreign Travel benefits.
Kaiser Medicare Advantage does not cooperate with independent agents. So we will not be able to service you on your Medicare plans at all.
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.
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

Filed Under: Health Insurance, Medicare Plans Tagged With: 24 Month Rule, 65+, AARP, Age 65+, Alta Bates, Anthem, Anthem Blue Cross, Blue Shield, Brown & Toland, Center for Medicare Medicaid Services, CMS, CPMC, guarantee-issue, Health Care Plans, health insurance, Health Insurance California, Health Net, Health Plans California, HMO, ICEP, Initial Coverage Enrollment Period, John Muir, John Muir Medical, Kaiser Advantage, Kaiser Medicare Advantage HMO, MA-PD, Medicare A and B, Medicare Advantage 24 Month Rule, Medicare Advantage HMO, Medicare Advantage Trial Period, Medicare Advantage., Medicare F, Medicare Gap, Medicare Gap F Plan, Medicare Gap Plan F, Medicare Gap Plans, Medicare HMO, Medicare MA-PD, Medicare PDP, Medicare Plan F, Medicare Rx, Medicare Supplement, Medicare Supplement Plan F, Medicare Supplement Plans, MedSupp, Original Medicare, PDP, Scan Health, Seniors, Stanford Hospital, Trial Period, UCSF, UHC, United Healthcare

Medicare Annual Enrollment Period (AEP) 2015

October 8, 2015 By Phil Lee

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or an Individual & Family Health Plan)

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:

Enroll or change your Medicare Advantage plan (MA-PD).
Enroll or change your Medicare Rx (PDP) plan.
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.

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.