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Medicare Open Enrollment--what do you need to do? And when?

10-14-2016by Colleen King

It's that time again, the Medicare Annual Election Period (AEP) where you can make changes to the plans that augment your Medicare--which one is best, which one will do the most for you, how do you decide? All of those blasted Medicare related commercials, what are you to believe?

The Medicare AEP is when you can make changes to your Medicare Advantage plans or Part D drug plans. AEP starts October 15th, ends December 7th, with any changes you make taking effect January 1. This does not apply to Medicare Supplements, not sure why, but they are regulated differently--my opinion wasn't sought. We'll talk about that in another article.

Medicare Advantage plans--These will fill in some of the gaps on your Medicare, and most will include your Part D drug coverage. Most of these are HMO plans if you're in Southern California, and if you're in Los Angeles County, several of the Medicare HMOs have no premium above your Part B premium. These can be really cost effective options--some have no office visit or hospitalization copays--wow! The potential drawback? They are HMOs, so you have to stay within a network. If you are used to commercial (under age 65) HMOs, these could be a good way to go if your preferred doctors are contracted. Medicare HMO network can be larger than commercial HMOs because doctors are realizing their patients are getting older.

Medicare PPOs--there are some but they are fewer and farther between. These are part of the Medicare Advantage series of plans. And most of the time, like commercial PPOs, you can count on more out of pocket expenses, even if you stay 'in network,' that's just the nature of the beast.

Part D drug plans (PDPs)--If you have a Medicare Advantage plan (HMO or PPO) you usually do NOT need a drug plan, it's included in the plan. In fact if you try to enroll in one, it will kick you out of your Medicare Advantage plan. You will need a PDP if you have a Medicare Supplement because those do not cover drugs. There are about 25 PDPs in California, and which ones will fit your needs best depends on your medications and your preferred pharmacy. It's definitely case by case.

Bottom line--work with an independent agent. There is no cost to you with an independent agent. In order to make recommendations, we do the work of checking out who your doctors are contacted with, which plans will cover your medications best, at least that's what I do and my agent peers as well. You can do it all on your own, call each carrier, try to decipher all the information and pick a plan. And while the carrier reps are nice people for the most part, they will all try to call you back to follow up. Aetna, Anthem, Blue Shield, Silver Script, Health Net, AARP/United Healthcare, Humana and SCAN--all will call you back. Work with an agent you like and trust, and just have one person calling you back rather than several. After all, you have better things to do with your time!


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CalPERS looking to raise premium on their long term care coverage 75%–why?

10-04-2012by Colleen King

On a good day, long term care insurance is not cheap but it can be reasonable for what you get if you get it when you’re younger. But in this article CalPERS is looking to potentially raise rates 75%? Is that reasonable, can they do that?


Yes they can do that–even though they offer a ‘Partnership’ plan. These offers asset protection for people who exhaust their policy then need to potentially qualify for MediCal, and have certain parameters in place especially around rate increases. But the CalPERS plan is exempt from this because they are what is referred to as ‘self funded.’


Normally one buys insurance (this applies to health insurance also) and the insurance company pays for care. When a long term care or health insurance plan is ‘self funded,’ that means there is a ‘check book’ figuratively speaking, and the plan sponsor, which in this case is CalPERS, pays the claims. The CalPERS plan has been closed to new enrollment for at least a couple of years now, so you have no new, young blood (or money) coming in.


So that’s why I urge my clients who are eligible under CalPERS to consider long term care insurance outside of the State’s plan. There are no restrictions on rate increases, there are other limitations in the duration of the of the plans offered, and it’s starting to look like there could be a sustainability problem. Ya think?

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Health care reform, Anthem rate increases, it’s going to be a busy month folks!

09-12-2012by Colleen King

There have been multiple articles in the Los Angeles Times and different online sources about rate increases, health care reform and what it all means. The kicker is, on the health care reform front, no one really knows because it hasn’t all been figured out.


David Lazarus’s article in the Times yesterday about a woman’s rates increasing with Blue Shield is happening all over. Blue Shield, Anthem, Aetna, Cigna, Health Net, they are all having ‘rate actions.’ And since most of my business is with the first three, I’m busy trying to move my folks around.


What makes it difficult at this point is that big unknown called health care reform. Anthem is not quoting anything after September 22, because the reform rules are taking effect September 23. Other carriers are saying according t one of my sources, that they don’t have to comply until either October 1 or January 1. So who are you to believe?


Aetna and Cigna have come out and said they won’t be doing ‘child only’ policies after October 1 because the rule about ‘no pre-existing conditions’ goes into place September 23 if you are under age 19. I’m very curious to see what that is going to do to rates for people with kids on their plans. Supposedly, you wouldn’t be able to ask any health related questions which determines conditions, which determines whether they will be accepted and at what rates. And you don’t think the carriers are really going to ‘low ball’ this, do you?

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What’s an insurance exchange?

08-21-2012by Colleen King


You may be hearing about this more and more in the news these days. Will they be of help to you? Here’s some info, with a bit of my ‘opinion.’

Health care reform proponents wanted to create a ‘marketplace’ where people could go to compare different types of coverage, get help figuring out what plan will work best for them. In the insurance agent community, we weren’t exactly sure what that meant, since wasn’t that we did already? Go to my web site, check out the plans, or call me and I’ll check some out and make suggestions, all without creating a new government agency.

There is still LOT to be done in establishing the exchanges as each state is to create one, or if they don’t want to, the federal government will do one. The biggest difference, is if you are eligible for a subsidy from the feds to purchase coverage, you can ONLY buy from the exchange. Agents in California supposedly are going to be able to offer plans through the exchange, but details on that will need to be worked out–like commissions.

There is a lot more to be figured out, like cost, what will the plans look like, which insurance carriers will be participating, and this needs to be created for both individual/family plans and small group plans. Will it help affordability? Not sure, that will take some time to figure out. And keep in mind, it all has to be up and running by January 1, 2014. Not very far off….
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Category: Uncategorized


Expensive health care, mediocre results–really?

11-30-2011by Colleen King

While Americans continue to brag about their marvelous levels of care, well at least some Americans, our quality apparently isn’t up to snuff.

Life expectancies, hospitalization rates, cost of care, we’re trailing on an international level. America rates well in cancer care though, according to this article. Switzerland’s system is touted as being effective, and significantly reduced cost, but scroll down to the comments and you will see that while they do have a private insurance system, reimbursement for care and insurance rates are highly regulated. Payments are based on a fee schedule. Take 2 minutes and read this article I found on California Healthline, and you’ll find some interesting statistics on the costs involved with health.

Also interesting is how lack of access is cited as a big problem in the US, not obesity, smoking, etc., the usual suspects.

So what do you think?
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Category: Uncategorized