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So, how are things looking for health care reform, repeal and replace, and so on?

2017-10-10 by Colleen King

Every once in a while a Robert Laszewski article comes up that really strikes me. His articles and interviews are always good, but this last one talking about 'Zombiecare,' and how association plans are potentially problematic really is worth a read. Click here to read a transcript of an interview from October 8th, or watch the video version of it. It's worth your time.

He talks about something I've recently mentioned, the penalties for being uninsured, or not having 'ACA acceptable' coverage. The IRS was told by Pres. Trump not to enforce these penalties at tax time. So what is your accountant to do, they are really stuck in the middle on this. You should still have coverage, but rates are going nuts, and now you're facing penalties if you don't have it, ugh!

Association plans--that's another buzz term that's been flying around. We'll let a bunch of people band together, they can buy plans across state line, that will cut costs. Problem is, who's going to regulate them? Insurance is regulated state by state. Different states have all sorts of laws around what they have to cover, so as you go from state to state, will things have to be added in in order for a plans to be sold in certain states? Who knows. How about rates? You have a plan based in say Alabama, where the cost of care is lower than states like California and New York, and when the claims from California and New York come in, then what? That will impact rates and drive them up eventually.

What about networks across state lines? That's another issue, and not just for HMOs. People tend to refer to PPOs as plans where you can go to 'any doctor'--this is true, but if the doctor is contracted with the insurance carrier, you pay less for their service that if you see them on an 'out of network' basis.

So in short, so far, NOTHING has changed. Open enrollment for individual plans starts November 1, and for California, will run through January 31st, 2018. BUT, if you want your plan change to start January 1st, you do need to get applications submitted by December 15th.

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Category: Health care reform



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

2017-10-04 by 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?

2017-10-02 by 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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