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

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

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

Individuals and Families
• Insurance Carriers are expected to release their health plan offerings for 2014 on Oct. 1st.
• The major carriers offering Individual/Family plans in the Bay Area will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
• Individual & Family purchase mandates and penalties will go into effect on Jan. 1st. Large Employer Group (50+ Employees) mandates and penalties, however, have been postponed to 1/1/2015.

Small Employer Groups (50 or fewer employees)
• Model Notices — All Employers are required to give “Model Notices” to all their employees by Oct. 1st, and to new hires within 14 days of hire. This is a Dept. of Labor mandated notice, that talks about employees’ and dependents’ options, under ACA, to employer and individual health coverage, Exchanges, subsidies and tax credits.
• Previously, this Model Notice law carried a penalty to Employers of $1,000 per employee for non-compliance. Last week, the Dept. of Labor announced a waiver of the penalty for non-compliance. But they still want employers to send out those notices.
• Anthem Blue Cross will not be offering any Small Group health plans within the Covered California Exchange. But they will be offering a wide selection of non-standardized plans outside of the Exchange.

Large Employer Groups (50+ employees)
• Model Notices — Penalties waived, see above.

Medicare Individuals
If you are on Medicare, you are mostly unaffected by the implementation of ACA on Jan. 1st.

Phil Lee

Your objective should be to:
1. Be insured.
2. Find the most affordable plan for your needs.
3. Qualify for a subsidy or tax credit, if you are eligible.

Individuals and Families
1. Major carriers participating in the Individual Exchange will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
2. The guarantee-issue rule for individual health plans will go forward as planned on Jan. 1st. Individuals and Families may enroll between Oct. 1st 2013 and March 1st 2014. Enrollment effective dates will be Jan. 1st or later.
3. Starting on Oct. 1st, Individuals and Families may start choosing and applying for Individuals health plans within Covered California (the State Individual Exchange) or from plans available outside the Exchange. Plan choices within the Exchange are likely to be more limited than plan offerings outside of the Exchange. However, if one needs a federal subsidy based on their income, they may only apply for plans within the Exchange.
4. Agents who are certified by the Exchange may offer health plans both inside and outside of the Exchange, and may assist consumers in applying for subsidies.
5. Federal and Cal Cobra will continue to be offered to terminated employees.

Small Groups (under 50 employees)
1. Major carriers participating in the Group Exchange, aka SHOP, will be Blue Shield, Health Net and Kaiser.
2. Tax credit will be available to employer groups with low salaried employees.
3. Most insurance carriers allow existing groups to renew early in Nov. or Dec. of 2013 so that they will not be subject to the new Jan. 1st ACA-compliant plans and rates for another 12 months.
4. 2 employee groups consisting of only the owner and spouse will no longer be allowed.
5. 1099 employees will not be considered employees for group eligibility.
6. Employer groups in CA must have 51% or more of its employees in CA in order to qualify. Out of State employees may enroll in an Individual/Family plan in their own state.
7. Agents who are certified by the Exchange may offer health plans both inside and outside of the Small Group Exchange, known as SHOP.
8. Flex Spending Account Salary Deferral limit of $2500 for 2014.
9. Employer Model Notices requirement – On Oct. 1st or within 14 days of hire.

Large Groups (50+ employees)
• The employer mandate to provide a minimum level of health insurance to employees, along with the associated penalties; have been delayed to Jan. 2015.

Medicare
• ACA and the Exchanges are not expected to affect Medicare.

For More Information:
Please go to the official website for the California Exchange, aka Covered California, at www.coveredca.com. You will find:
• Summaries of Exchange plans that will be available.
• Sample rates for Exchange plans for your age in your zip code.
• A calculator to help give you some idea if you might qualify for a subsidy.

Phil Lee
www.Health-Insurance.com
www.HealthPlanTalk.com

This raises the following questions:

·         Why did CMS not already have a competitive bidding process in place?  Don’t all Government programs (including the not so frugal Pentagon) routinely use competitive bidding to curb fraud, waste and abuse?

·         Why did CMS wait so long for ACA before implementing such an obvious cost-saving procedure?

·         What other Medicare benefits, other than oxygen tanks, are also experiencing rampant fraud, waste and abuse?

·        Would a private insurer, if they were operating such a program, have allowed such rampant abuse to occur unchecked for so long?

Medicare was originally designed to be an insurance program.  This is more evidence why this program is inflating the nation’s deficit.  It’s become an unfunded Government program with out-of-control spending at Pentagon prices.

More details and links to full story below:

NAHU Newswire April 19, 2012:

Medicare To Expand Bidding Program After Pilot Saved $202 Million In First Year.

USA Today (4/19, Kennedy) reports, “A new competitive bidding pilot program that replaces Medicare fee schedules for durable medical equipment – such as wheelchairs, oxygen tanks or diabetic test strips – has saved Medicare $202 million in its first year,” according to a report by the Centers for Medicare and Medicaid Services (CMS). “Beneficiaries also saw 42% in savings in their co-insurance payments for medical equipment.” The CMS report also projects that “the program, if expanded nationwide, could save seniors and people with disabilities $17.1 billion over the next 10 years.”

The New York Times (4/19, B1, Pear, Subscription Publication) reports that Secretary Sebelius “said the pilot program had reduced Medicare costs by 42 percent, or $202 million, by securing lower prices and curbing ‘inappropriate utilization’ of personal medical equipment.” She added that “the savings showed the value of the” Affordable Care Act. The story says, “the bulk of the savings came from oxygen equipment, power wheelchairs and mail-order test strips for people with diabetes.” CMS deputy administrator Jonathan D. Blum “said the switch to competitive bidding had not compromised beneficiaries’ access to the items they needed,” and that “Medicare had received few complaints from beneficiaries in the last year.”

The AP (4/19, Alonso-Zaldivar) reports, “The nine-city crackdown targeting waste and fraud has drawn a strong protest from the medical supply industry, which is warning of shortages for people receiving Medicare benefits and economic hardship for small suppliers. But the shift to competitive bidding has led to few complaints from those in Medicare.” It will be expanded “to a total of 100 cities next year, along with a national mail order program for diabetes supplies.” The story quotes Blum saying, “Costs are lower and there is no impact on the health status of our beneficiaries.”

CQ (4/19, Reichard, Subscription Publication) cites Blum saying that “contrary to the claims of critics, the program hasn’t led to disruptions in access to products … Nor has it led to adverse health effects requiring more hospital, doctor, or skilled nursing care.” In response, “Michael Reinemer, spokesman for the American Association for Homecare (AAH), said ‘we don’t find that credible,'” adding, “We documented four or five hundred complaints from patients or clinicians.”

The Hill (4/19, Pecquet) in its “Healthwatch” blog cites the CMS report and the AAH dissent.

www.health-insurance.com
www.healthplantalk.com