Understanding Medicare Enrollment Periods

Medicare Insurance can be very complex for the average Joe to understand. You think trying to understand all of the insurance elements is difficult? How about understanding when you can change from your current Medicare Insurance plan. That is a common topic that has been arising more often these days and we want to address this issue.
Medicare Enrollment Period
Let’s start from the beginning. Your Initial Enrollment Period (IEP) starts at age 65 and you can enroll as early as 3 months prior to your birthday month and it ends 3 months after your birthday month. So if your birthday is in April, you can start enrolling in Part A & B in January and you would have until July to have something in place. If you enroll in the 3 months after your birthday month, your Medicare coverage will start the 1st of the following month that you enrolled.

The next and most common period is the Annual Open Enrollment. (AEP) which we have previously discussed. In a nutshell, it’s the time of year when you can change your Medicare Advantage plan to another Medicare Advantage plan of equal or lesser value. More often than not, you will change to a plan that has better benefits or maybe your current plan is no longer going to be offering services in your region.

The most difficult to understand is the Special Enrollment Period (SEP). There are multiple qualifying events that would qualify you for a Special Enrollment Period if:
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  • You lost your creditable drug coverage due to no fault of your own
  • You drop employer/union health and/or drug coverage from current or former employer
  • You are institutionalized
  • You are enrolled in a qualified State Pharmaceutical Assistance Program (SPAP) or lose eligibility
  • You have Extra Help (State Medicad or SSI benefits)
  • You want to disenroll from the FIRST Medicare Advantage plan you ever enrolled in
  • You enroll or disenroll from PACE
  • You permanently move (Your coverage may not be available)
  • You join or lose eligibility for a Special Needs Plan (SNP)
  • You have had Medicare eligibility issues (retroactive enrollment)
  • There was Contract violations, misleading marketing or enrollment errors from your current carrier
  • You current Medicare private health or drug plan no longer offers it in your area
  • You disenroll from your current Medicare Advantage plan from Jan 1-Feb 14
  • You experience a n “exceptional experience” by request to CMS only
  • You qualify for a new Medicare Part D Initial Enrollment Period at age 65

These events will allow you to make the necessary changes to your Medicare Health plan. However, some of these Special Enrollment Periods only last for a specific amount of time so do not procrastinate! For more information on Medicare Insurance please talk to one of our insurance professionals for updates, news, quotes and online applications.

Medicare Supplement Insurance Plan F Explained

Medicare Insurance has never been this complicated! With so many changes in Healthcare Reform over the past 18 months, seniors today have to become experts to know which plan is best for them. Will it be around next year? Can I switch if I’m not happy with the benefits? These are all great questions to ask and better yet, know the answer to.

The safest way to go when it comes to your healthcare in your “golden years” is to protect yourself with a Medicare Supplement Plan.This means that the you will have Original Medicare, Parts A & B, as your primary medical insurance. A Medicare Supplement or Medigap plan will cover the cost that Medicare does not cover. This includes co-pays, co-insurance and other expenses.

Medicare Supplements Plan F has recently become the Cadillac choice for seniors today. Essentially it covers almost all of your potential out-of-pocket expenses that Medicare does not. Other plans such as Plan N or Plan G still leave some gaps that could potentially be devastating financially. For this reason the Plan F is your best choice when considering your options of a Medicare Supplement.

The greatest part is that the Plan F is the same no matter which carrier you decide to choose. In any city, county or state – the benefits remain the same! My advice is to shop around and make sure your getting the best price for the plan as each carrier sets their own price for their service. Some carriers even add Silver Sneakers or other health and wellness benefits that other do not, usually at no additional cost.

Now that you have your Supplement insurance squared away, make sure you also procure a Medicare Part D, better known as a Prescription Drug Plan. Neither Medicare nor your supplement plan will cover your monthly prescriptions and it is imperative that you seek the best plan for you based on your needs and budget. If you fail to do so, penalties may be imposed on you later and you will pay a higher rate for as long as you are on Medicare.

Lastly, a common misconception is that when you have a Plan F, regardless of your carrier, you are not bound by their network of providers. Remember, you have Original Medicare as your primary insurance and thus you can see any provider who accepts Medicare! Your supplement just covers the difference, so they don’t care who you have as your Supplement carrier as long as they get paid.

For more information on Medicare Insurance please talk to one of our insurance professionals for updates, news, quotes and online applications.

Blue Shield Agrees to cover Autism Therapy

It has just been reported that Blue Shield of CA has recently agreed to pay for certain Autism therapy, which they had previously denied claims for. The treatment – Applied Behavior Analysis or Behavioral Intervention Therapy – consists of sessions with a therapist who uses conditioning techniques to influence behavior. Blue Shield is not the only carrier who has denied this claim. Many other have also denied these claims in the past citing that it is not a medical service and therefore should not be required to pay for.

This agreement will take place immediately and will only affect those covered under Blue Shield policies that are overseen by DHMC. Under this agreement, Blue Shield agreed to no longer deny such claims for Autism therapy and will reimburse those policyholders whom they had previously denied.

It has been rumored that Anthem Blue Cross and Kaiser Permanente are also in talks with state regulators to abide by the same agreement. In addition, a bill has been introduced that would require all California health plans to cover this therapy.

SoCal prepares for Fire Season; Is Your Home Insured?

Today, the Insurance Commissioner reminds all California homeowners to complete a home inventory due to the Fire Season that is likely upon us. “The extended rainy season this spring has created even more growth of brush and recent storms have caused trees to fall and loosen limbs, adding more fuel should a wildfire start,” said Commissioner Jones. “Homeowners need to be extra vigilant when evaluating their homes and property. It is imperative that homeowners create defensible space around their property, make an inventory of their possessions, and prepare their families with an evacuation plan should a wildfire strike.”

In case of fire damage to your home it would be great to have proof and evidence of your belongings in case they are destroyed. Here are some tips to help:
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  • Photograph and catalogue all of your possessions.  Photographs are helpful when you cannot provide a purchase receipt.
  • Label your photographs with pertinent information about each item.
  • Video is also useful, just be sure to use commentary throughout.
  • A copy of inventory including purchase receipts, model & serial numbers should be stored in a safe place.
  • Keep all of your insurance policies and important financial documents in a safe place such as a safe-deposit box.


Lastly, remember to review your homeowners’ insurance policy or ask your agent to make sure you have sufficient coverage limits for the dwelling, personal property and any special valuables.

Serencsa Settlement: Reinstate Your Anthem Blue Cross Policy

This settlement is a one time offer that will allow individuals who had coverage active with Anthem Blue Cross on September 23, 2010 to reinstate a health insurance policy with NO Medical Underwriting. Only the primary policyholder and dependents that were active at the time of cancellation will be eligible for this offer.

Whatever the reason was that you let your policy lapse, you can have it reinstated if you submit the proper forms to Anthem Blue Cross no later than July 31, 2011. You will have the opportunity to select from Anthem’s new product line and because you and your dependents will not be subject to Underwriting, any possible pre-existing conditions will be waived.

Once you decide on a plan and submit the forms, your new plan will take effect as of August 1, 2011. Any Request Forms received after the announced deadline will not be considered for re-enrollment unless you would liked to be put through the traditional underwriting process.