Open enrollment for Medicare Advantage and Prescription Drug Plans will open on Wednesday, October 15, 2014, and continue through midnight Sunday, December 7, 2014. During this 45-day period, all Medicare beneficiaries may enroll in, disenroll from, or change to a different Medicare Advantage plan. All persons who are enrolled in both Medicare Part A and Part B are eligible to enroll in Medicare Advantage -- this includes persons who became eligible for Medicare due to disability prior to age 65 and have been receiving SSDI benefits for at least 24 consecutive months.
And don't get scammed by persons trying to enroll you in Obamacare!!
If you are enrolled in, or eligible to enroll in Medicare, you don't qualify for advanced tax credits and you don't need to buy health insurance through the Covered California health benefits exchange. Report anyone trying to sell you health insurance not referred to as Medicare Advantage or Medicare Supplement insurance -- or asking you to write a check or give them cash to be enrolled in Obamacare -- to your local law enforcement agency immediately! And don't talk to anyone who approaches you unannounced or uninvited -- they are prohibited from doing that.
Medicare Advantage represents value!
Medicare Advantage (MA) HMOs and PPOs represent some of the best values for Medicare beneficiaries when it comes to obtaining health care services compared to "Original" Medicare, with or without a Medicare Supplement insurance plan. Generally, MA participants enjoy a broader range of services, significantly lower out-of-pocket expenses, and access to established networks of physicians, surgeons, and other health care professionals who might not otherwise choose to treat Medicare patients. Most MA plans also provide coverage for many of the things that Medicare excludes, such as "routine orthopedic care" of bones and joints, as well as vision (eye exams and prescription lenses) and dental benefits.
"MA-PD" plans also include a Prescription Drug Plan (PDP) that most Medicare beneficiaries are required to purchase if they do not have creditable coverage through an employer-sponsored plan or standalone PDP (if you are enrolling in most HMO or PPO plans, the plan must include the PDP, it is not an option). Each MA plan that offers a PDP will have its own "formulary" -- a list of covered medications -- so it's very important to know whether your medications are included in a plan's coverage, and to what extent.
Enrolling in a Medicare Advantage plan can be accomplished by visiting the official Medicare website -- use the link to Medicare.gov at the bottom of this paragraph -- by contacting any of the insurance companies which offer Medicare Advantage plans, or licensed insurance producers who are certified by those insurance companies to enroll persons in Medicare Advantage plans. In order to be certified, each of us must complete an annual training program, take a series of exams, and pass the final exams with a score of 90% or better (on the first, second, or third attempt). All insurance producers must also be "appointed" as an agent of the insurance company.
And you don't pay anyone for advice either!
Seeking the services and advice of an experienced insurance producer does not cost a Medicare beneficiary anything. One of the particular advantages enjoyed here in California is that in most areas of the state, MA plans are available with no additional premium expense out of pocket -- a benefit of our population demographics and good, old-fashioned competition. When a person enrolls in a MA plan, the US Government pays that insurance company a monthly fee which it uses to defray the cost of providing care to its enrollees. You don't even have to write a check to enroll!
The benefit of using a licensed insurance producer cannot be downplayed. He or she will be able to explain how Medicare Advantage works in comparison to Original Medicare (with or without a companion Medicare Supplement (or "Medigap") insurance policy), and how you may save money by choosing one of the available plans in your area. There are a variety of MA plans other than HMOs and PPOs, such as Private-Fee-For-Service (PFFS), Medicare Savings Accounts (MSA), and Cost Plans (low cost care inside the HMO network, and Original Medicare coverage outside the network when using Medicare-approved providers), as well as Special Needs Plans (SNP) for persons with certain chronic health conditions. For some low income persons, there may also be Medicare Advantage-Medicaid hybrid plans available. Trying to figure out the differences and what they mean to you (or a parent or grandparent) can be a genuine challenge. You don't have to try to figure it out on your own.Insurance professionals cannot charge anyone for their services, and you cannot be given any "gifts" to encourage your enrollment in any plan. We are paid a commission by the insurance companies with whom we place your business, and the amount of compensation is strictly limited by the Centers for Medicare and Medicaid Services ("CMS"), and regulated under federal and state laws. Generally, all insurers and their Medicare Advantage plans offer agents the maximum commission available, so agents do not have an incentive to "sell" you one plan compared to another. In fact, agents MUST disclose their compensation as part of the enrollment process.
Our responsibility to you is to make sure you select a plan that meets your needs, provides the benefits that will be most important to you, include the doctors and other health care professionals you are already using in their network, and how well its past performance has been rated by Medicare.
Most importantly, federal marketing rules for Medicare Advantage and Medicare Supplement insurance ABSOLUTELY PROHIBIT "cold-call" solicitations by agents -- those annoying phone calls that you did not invite. In fact, agents cannot even approach you to offer you information about Medicare Advantage or Medicare Supplement insurance plans. We can set up a stand at a hospital or pharmacy, but have to wait for you to approach us. We cannot send you emails if you haven't given the insurance companies we represent permission to do so in advance. Everything must start with you! You must ask for the information, you must ask for the agent to visit you in your home.
When the agent comes to meet with you, unless you ask about other health-related insurance products that were not listed on the "Scope of Appointment" notice you must be given AT LEAST 24 HOURS IN ADVANCE of that meeting, he or she cannot discuss any other types of insurance with you at that time . . . ABSOLUTELY no discussions of life insurance, annuities, homeowners, or auto insurance, mutual funds, stocks, or bonds . . . and no sales of laundry detergent or other consumer products or services.
You can also obtain information at no cost from the Health Insurance Counseling and Advocacy Program office nearest to you. Click on the link below to open a window to that website operated in conjunction with the State of California's Department of Aging. Be sure to download the Medicare Fraud Toolkit on their publications page.