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Colleen King - Blogs

Medicare related coverage



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

10-14-2016 by 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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Medicare Advantage Plans–your opportunity to change for this year is almost up!

03-14-2009 by Colleen King

There aren’t too many things more complicated that the collection of Medicare Advantage plans available to our Medicare population. There used to be Medicare HMOs and Medicare Supplements. Well Medicare Supplements are still around and serve a great purpose; they work similarly to a PPO health insurance plan because you can go to any doctor. You also pay a monthly premium for these.




Medicare Advantage plans include Medicare HMOs, Regional PPOs and Private Fee for Service plans (PFFS). Yikes! Remember last year when you were deluged with Medicare commercials, after surviving the political commercials? “Sign up now before open enrollment ends!” Well, for existing Medicare Advantage plan members, January 1 through March 31is your LAST last chance to make a change to a comparable Medicare Advantage plan for 2009. And the great thing about these is they have little or no premium cost to join. None of this date and change related information applies to Medicare Supplement members.


So if your friends or parents or some other relative hasn’t been happy with their Med Advantage plan, now’s the time to change or forever hold your peace. Until NEXT November 15 through December 31. Then it starts again! Tell them to contact the insurance company they want to change to or contact their friendly local insurance agent for help and recommendations.


Be well!

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Medicare open enrollment–need a change?

10-28-2008 by Colleen King

Medicare–the golden years–woo hoo! You finally have your red, white and blue card, health care until you ‘no longer need it’ is now taken care of. But are you okay with your current situation? Medicare alone does not cover 100% of everything so most people pick up additional coverage, which I will go through below.



Medicare Supplements and Medicare HMOs, also known as Medicare Advantage plans, are something to choose wisely. This is because as time goes on, like with regular insurance plans, benefits change and what you chose originally might not be working for you now.


November 15 through December 31 is Medicare open enrollment every year, and if  you have a Medicare Advantage/Medicare HMO plan and you aren’t happy, or your doctor is no longer accepting the plan, NOW is the time to make a change and you don’t have to go through medical underwriting to be accepted.


Medicare Supplements don’t have quite as liberal rules around changing, but there are ways of doing it. BUT, generally you will have to be able to go through underwriting screening and be accepted. And that’s usually the problem. When you initially become eligible for Medicare, you have a six month window (three months before and three months after your birthday) to enter any supplement plan that you want. No underwriting. You can be a medical train wreck and they will still take you. However, if you have a supplement and it’s become too expensive, you can make the change to an HMO plan during the annual open enrollment period.


In Los Angeles County, and several other counties in California, the Medicare HMOs (aka Medicare Advantage plans) are free, so if money’s getting tight a Medicare HMO might be a good solution to your situation. If you are having trouble navigating the coverage waters of Medicare associated plans, call your agent. Or me; I’d be glad to help you figure out your options.


Be well!

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Individual health insurance–explain guaranteed issue plans?

08-29-2008 by Colleen King

When dealing with Individual Health Insurance, depending on your personal health history, it can be dicey to apply because you don’t know whether you’ll be accepted or not and if you are, and are offered coverage at an above standard rate, will it be affordable? Depending on your situation there are some options in California, so we’ll look at a few of them. You can see this poor guy is trying to figure it all out in a song….


Light picture to get you through this subject...


If you are coming off a group health plan and have health issues, you are eligible for Federal COBRA for usually up to 18 months as a result of the Health Insurance Portability and Accountability Act (HIPAA). Problem is, if you’ve ever looked at the cost, if you didn’t have a heart condition before, you will now. You get to keep your exact same coverage, not subject to underwriting review, but you are now paying the full cost plus a 2-4% administration fee. NOW you understand the true cost of health insurance. Federal COBRA applies to businesses with more than 20 employees, but California, being the way we are, instituted CalCOBRA for companies with less than 19 employees. Similar rules around this, you can keep it for 18 months but you pay the full cost plus about a 10% administrative cost. And if you work for a 20+ company, you can take advantage of Federal and CalCOBRA for a total of 36 months coverage, if you can afford it.


What do you do when COBRA ends, or if you can’t afford COBRA and are uninsurable? Once you complete the full run of COBRA, the insurance carriers have guaranteed issue health plans you can apply for. But, the cost is often comparable to your COBRA coverage.


Option of last resort are a type of plan called a ‘mini med’ plan. These are not the first line of plans that I as an agent offer but when there is nothing else, it can help keep the wolf from the door. I work with one company that offers 3 different level plans and I usually try to encourage people to look at the highest level, contrary to what I usually advise. The carrier pays a fixed amount per day for hospitalization, a specific amount for office visits, they will help with some physicians and surgical charges and offer several discounts on other types of services such as vision, prescriptions, hearing aids, and so on. The monthly cost on these can often be better than your COBRA offering but not as comprehensive a type of coverage. But, it will help.


Again, not the first type of plan in my arsenal but when properly explained, there is a place for the mini med plan. They tend to be more popular outside of California and can also be found in the group health insurance arena as well when an employer wants to offer something but doesn’t want to break the bank.


Reform of the health care and health care reimbursement has been talked about intensely for well over a year in California. Don’t plan on it happening too soon, we can’t even get a budget passed. You need to be responsible for your own wellbeing so seriously consider looking into at least a high deductible health plan in case something major happens. Because comprehensive reform ain’t happening soon. Be well!

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Medicare–is it enough?

07-29-2008 by Colleen King

Medicare Supplements, Medicare HMOs, do you need anything more than original Medicare? Well, if you’ve looked at how it works, you’ll know that there can be some hefty costs especially if you are hospitalized.




Medicare Part A you automatically get at age 65 if you’ve worked a specific length of time in the US. This mainly covers hospitalization. The big expense here is that you have a deductible, and unlike most insurance plans, these are ‘per hospitalization’, not calendar year deductibles. in 2008, the Part A deductible is $1024, and this goes up pretty much every year. So if you are hospitalized in February, and then again a few months later for an unrelated problem, you’re hit with another deductible.








Part B you have to buy and this takes care of things more along the line of doctor visits and outpatient procedures. With Part B, this year the cost is $93/month and you have a $135 deductible, but that’s once a year. Where the expense comes in is that Part B is that it covers 80%, leaving you with 20% which of course can add up.


So, having some type of additional coverage is pretty important, especially for that Part A deductible! in order to have any of these additional types of coverage one does have to have both Parts A and B


First, there are two basic categories of ‘additional’ Medicare coverage, Medicare Supplements and Medicare Advantage plans. Medicare Advantage plans further divide into Medicare HMOs, regional PPOs, Private Fee For Service (PFFS) plans and medical savings account plans. I’ll be skipping the last two because the PFFS plans are fraught with problems and being phased out, and the savings account plans aren’t catching on.


Medicare HMOs function like regular HMOs, from the aspect that you pick a primary care doctor and you then have a network of doctors and hospitals that you get your care from. One advantage of these over the supplements is that during the annual open enrollment period, November 15 to December 31, you can change to another plan if you aren’t happy without going through underwriting–BIG plus especially as yu get older and have health issues. BEST part of these is that they are free in most counties, particularly in Southern California.


Medicare Supplements function more like a PPO, except that the ‘network’ for this are providers that take Medicare–leaves it pretty wide open. The plan designs are identical because they are designed by the federal government. Some carriers offer some limited extras, but mainly you want to look at the price of these. Comparable to these are the Regional PPOs. These are offered on a limited basis, they aren’t everywhere. And there is a network, the specific network for this product for the carrier you are insured by. Again, these may end up going by the wayside since the HMOs and Supplements by far blow away the competition.


So talk to your agent to see what is going to work best for you–Be well!

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