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It is the Medicare Open Enrollment time--what to do, and by when?

10-04-2017by Colleen King

Oh boy, 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. This year there are still 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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The Medicare Marketing Season is here--and?

10-02-2017by Colleen King

Yesterday was October 1st, the beginning of what we agents AND Medicare refer to as the Medicare Marketing Season. This is the point in time where we can start to discuss what's coming up in plans for the coming year. And you can tell it's the 'marketing' season, because all those god awful commercials start, you're getting tons of stuff in the mail, and even the radio is blaring about different plans, different benefits. But at this point we can only talk about it, we can't accept applications for anything. That start October 15th. At this time we can barely get supplies, because even though we've passed all sorts of certifications, and have been sworn to NOT discuss anything for 2018 outside of the agent-carrier circle, the carriers are still paranoid that someone's going to let the benefits out of the bag before October 1. But in the next 2 weeks, UPS and FedEx are going to be really busy.

All this stuff I"m referring to pertains to Medicare Advantage plans (MAPDs) and Part D Drug plans (PDPs). It doesn't' apply to Medicare Supplements, they are regulated differently. There are many kinds of MAPDs, but in my area, the Los Angeles/Orange County/Ventura County/Riverside/San Bernardino area, most of these are Medicare HMOs. There are a very few Medicare Advantage PPOs and a variety of other plan types that get confusing to discuss but I'm going to focus a bit on the Medicare HMOs. A lot of people cringe at the thought of an HMO, but these can be pretty amazing.

I'm not going to get into specific benefits of any plans, nor name any specific plans, because that gets into marketing and advertising, which means I have to submit what I'm writing about to that particular carrier potentially, and they have to send it to Medicare for approval. I'd rather just tell you about a couple of things I've found interesting. It's not uncommon for a Medicare HMO's network to be larger than a commercial HMO, the kind you may have had when you were working. The reality is, doctors are realizing their client base is aging, so even if they don't take 'regular' HMOs they may take a Medicare HMO. It's pretty easy to figure out, just ask your agent to check who your preferred doc is contracted with.

One thing that was a bit of a stand out to me is a fairly new benefit, not all carriers have it, but if you are looking at MAPDs, see if there is an 'OTC' benefit--this Over The Counter benefit will cover things like your nonprescription vitamins, bandaids, various things like that. You generally have to order these things from their vendor. There is a quarterly amount allocated, some carriers will allow unused portions to roll over, some not. But look for it if you're evaluating Medicare HMOs, it's a nice benefit to have!

So now's the time to figure out what to do for 2018 either for yourself or your parents. And don't go it alone, find an agent who is certified with several different carriers. it's 'free help' to you, and you end up having just one agent calling you back to follow up, not one from each company you called for information.

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Single Payer, Universal Coverage, what is the difference?

09-21-2017by Colleen King

There are a ton of terms being batted about, and sometimes you see people interchanging these two terms especially, and incorrectly. Then you see people talk about how great the Canadian system is, or the British system, or Germany's. They all have their pluses and minuses, as does our own US system.

Universal Coverage and Single Payer are not synonymous. Universal Coverage means that 'everybody' is covered, whether it's though private insurance companies or some sort of public/private option. Germany has 'universal coverage' through a variety of insurance companies. Single Payer means that there is just one 'payer' for services--this could be an insurance company, but it's usually a government entity. This is more in line with what Canada has. England is kind of in between, you have the National Health Service, government based, and then more 'well off' people may buy private insurance. If 'everyone' has one or the other, then you have 'Universal Coverage.'

For a really great comparison, please read the article attached. Written by Michael Lujan, it give a terrific descriptive comparison of how this all currently works between the four countries. Michael is very well known in the agent community, having worked in multiple aspects--as an agent, a rep for private carriers, even helped kick off Covered California, so he knows this business from all sides.

SB 562, the Single Payer bill in California, is back for 'hearings,' so it's definitely not dead. Is it a practical approach, would it work? Depends on who you talk to, so stay tuned.

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So, if you get your health insurance through your job, are you going to end up getting taxed on that?

08-17-2017by Colleen King

People don't always realize that when an employer pays some or all of the cost of their health insurance through work, the 'money' that is spent on the health plan is not considered taxable income to the employee. Congress, in the 'rush' to reform Obamacare and find funding for whatever they eventually come up with, is talking about removing the employer exemption and taxing YOU for what is being paid on your behalf.

And there's more than this involved--so if this happens, that increases your taxable income, and your employer's payroll taxes. Further, many times when people have their families on the group plan, smaller companies especially don't usually contribute to dependent costs because it's just too darn expensive. But usually, a 'cafeteria plan' (aka premium only plan, Section 125 plan) is set up to allow the pre-tax payment of employee costs, thereby lowering the taxable income to the employee, and lowering payroll taxes to employers. Presumably, this will go away too. This will increase the costs to the employee, take away money from your family, and so on.

Check out this article written by Janet Trautwein, CEO of the National Association of Health Underwriters, the national arm of my professional organization on the impact of this. Agents, aren't just in this for the money, we're looking out for the consumer, our clients, as well. Keep an eye out for this, we may need some letters written.




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So, should all health plans have to cover all things, or should we have some choice in what we buy?

07-07-2017by Colleen King

The goal with the Affordable (?) Care Act (ACA) was to cover the majority of health care related expenses for the most people possible. But did it go overboard?

Plans cannot have a 'life time maximum' anymore, but that's a big disingenuous because the majority or people never come near the $1-$7 million life time maximums a lot of plans had, ALL plans have to cover the 10 Essential Health Benefits outlined by the law, which include the following:

  • Outpatient care
  • Emergency Room Services
  • Inpatient Hospitalization
  • Maternity Care
  • Mental Health/substance abuse treatment
  • Prescription drugs
  • Habilitative/Rehabilitative service (things like physical therapy)
  • Lab services
  • Preventive services
  • Pediatric care, including the beloved Pediatric dental and vision

On the surface, this makes sense to an extent, but when you have to consider all of these items have to be 'priced in,' that drives up costs. Pediatric dental and vision is probably good, but I have a lot of clients not thrilled with this because either they don't have kids, or their kids are over 19 so they aren't covered. The same argument could be used for maternity care. It's covered across the board, whether you're male, over the common age to have a baby, whatever.

So here are my thoughts on what could be workable, based on what my clients have been happy with in the past, and would like to see now...

Maternity care--we used to have plans that did not cover maternity, which was okay for people not planning on having babies. Carriers should be able to offer plans that don't cover maternity, but to keep cost on maternity plans reasonable, there should be a requirement that it be covered on a certain percentage of plans, maybe 50% of what they offer?

Prescriptions--We used to have plans that covered generic drugs only, or some that had no prescription drug coverage. I don't necessarily want to go back to NO drug coverage, but people liked the 'generics only' plans, knowing that they might get hit if there was a brand drug needed. They were willing to take the chance.

Pediatric dental and vision--this may be a good thing, but there are NO dollar limits on the amount of pediatric dental care, and no waiting periods for major services. Braces are covered, but only when 'medically necessary,' and as most of us know, often times braces are more cosmetic in nature. Any time there are no 'limits,' you're setting things up to be taken advantage of. Maybe there needs to be an annual limit, more generous than the typical $1000/year, but not unlimited.

Habilitative/rehabilitative care--this is a tough one. There don't appear to be limits on the number of visits, it's going to be based on 'medical necessity.' These are services like physical therapy, occupational therapy and speech therapy. There are many scenarios that are not '12-20 visit' situations but when I was a utilization management nurse years ago, we saw a ton of abuse in PT and chiropractic care. And speaking of Chiropractic care, it's not a 'required' service, and now most plans don't cover it! Can we go back to this at least being covered in some way under the physical therapy benefit? That's nuts!

The rest of these are pretty broad, it would take weeks of writing to delve into these. We used to have higher deductible plans, some with  50% coverage after meeting the deductible. Plans like that weren't for everybody but for some of my older clients, they liked those because it helped to keep premium costs down, they had savings if something happened. I heard many times from clients 'I just don't want to lose my house if something major happens.' Makes sense! Let's bring back some sanity to all of this.

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