Bastille Day falls on July 14^th every year. Lately, septuagenarian Pritella Pratt felt like storming a few Bastilles herself, and she wasn’t even French. She did enjoy French salad dressing on her Romaine lettuce, and had eaten French fries, but that doesn’t count. But on Bastille Day, 2010, the French Independence Day, Pritella was in a hurry and tripped coming down some cement steps. She kept her balance, but it was Pritella’s pratfall nonetheless, as by evening of that day, several hours later, she felt a sharp nagging ache in her lower back. What was Pritella to do? She called Mabel, her beloved California Health Insurance agent (Mabel had also been her pinochle partner when her husband had been alive), to learn if her Medigap supplemental coverage was still in effect. “Yes indeedy,” Mabel said in her strange Irish brogue, “it is.” Medicare was great, but after Plan D of the Bush years, she didn’t know what to expect. She rushed out of her house, headed for her car, a Studebaker, and tripped, more seriously this time, a second pratfall. “I’ve fallen and I can’t get up!” she whispered as loudly as she could. Several more such vocalizations left Pritella feeling very old indeedy, and now her back was much worse. It was still Bastille Day, but almost dusk. A crow was cawing. Finally a good Samaritan named Sam came by, and helped Pritella to her Studebaker. Deep down the seventy-six-year-old felt a sprig of hope, like a probing tendril, because of Mabel’s affirmative words “Yes indeedy.” Those precious words were all that mattered now. Three blocks later, the urgent care center came into view. She could have walked there if it weren’t for her pratfalls. It was now dusk and a second crow cawed. Her back was killing her, perhaps literally as she didn’t know what was wrong.  Feeling a surge of “old lady” adrenalin, she managed to open the glass doors, and walked into the health care facility. “I’ve got Medicare, and Medigap supplemental,” she proudly said when asked by the receptionist, and promptly fainted.

It turned out that she’d “ruptured something,” and she needed to go the hospital for observation. Waking up in her hospital bed, her first thoughts were of Mabel – and not the bill.

74-year-old Padraig O’Brien loved to watch those scooter commercials on TV. “You can have your scooter, with no out-of-pocket expense,” the announcer crooned. Like several of his friends at the Elysium Trailer Park in Oxnard, Padraig was otherwise confined to a wheelchair. One day Padraig and several peers purchased dandy electric-powered scooters using their Medicare Supplement insurance policies to help defray their cost.  Visiting the Grand Canyon while maneuvering among crowds of tourists on their scooters didn’t appeal to anyone at Elysium, but once everyone had their scooters, something else became evident:  the thrill of scooter speed.

“I think we should set up a race track,” suggested Tony Pilano, at 79, a near-octogenarian assumed to be Elysium’s resident sage. Mary Falafel, who spoke Arabic but wasn’t a 73-year-old terrorist, preferring to decorate or draw, agreed. “I can make banners,” she said. She loved to draw nude men.

The race track was set up along the trailer park’s wide walking paths. In preparation for the big scooter race, the “main drag” was clearly marked by Mary’s banners, a few of them rather lewd. Fourteen scooters set to race lined up. Someone had brought a starter’s pistol. The electric hum of racing scooters was vaguely reassuring to many in the crowd of geezer gawkers. 

Tony and Padraig jousted for the lead, each rubbing the other like NASCAR drivers. Mary was running a strong third. As her scooter tipped, she reached for what she thought was a convenient handle …

 Exactly what occurred in those next crucial two seconds will never be precisely known.  

The aftermath featured the friendly California Health Insurance agent dutifully tying up loose ends after the participants had returned to Elysium. Mary brought up what was on everybody’s mind. “Let’s have another race,” she exclaimed.  A silence ensued leaving her words hanging in the California air.

A tear formed in Padraig’s eye.  “Tony would have liked that,” he concluded.

Annual Election Period (AEP)
The Annual Coordinated Election Period runs from November 15 through December 31 each year. Medicare beneficiaries can change Medicare Advantage plans or change their Part “D” prescription drug plan during this time frame. During this time frame a Medicare beneficiary can also choose to return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.

Open Enrollment Period (OEP)
The Open Enrollment Period extends from January 1 through March 31. During this time Medicare beneficiaries have one opportunity to enroll in, disenroll from, or change a Medicare Advantage plan. The change in Medicare Advantage enrollment or disenrollment becomes effective the month after the change is made.

Only Medicare beneficiaries who are eligible to enroll in a Medicare Advantage plan may make a change during the Open Enrollment Period. A beneficiary who has both Medicare Part A and Medicare Part B and wants to change must live in the area served by the Medicare Advantage plan.
During the open enrollment period beneficiaries may not add or drop Part D drug coverage. Medicare beneficiaries who already have drug coverage can only change to another plan that provides drug coverage. Medicare beneficiaries who do not have drug coverage may not change to an option that provides drug coverage.

Permissible changes during the Open Enrollment Period include:

-MA-PD to Original Medicare and a PDP
-MA-PD to a different MA-PD
-MA-only plan to original Medicare
-Original Medicare and a PDP to an MA-PD
-MA-only plan to a different MA-only plan
-Original Medicare to a MA-only plan

Beneficiaries who want to use the Open Enrollment Period to return to Original Medicare from an MA-PD must do so by enrolling in a PDP. Enrollment in a PDP during either the Annual Coordinated Election Period or the Open Enrollment Period terminates enrollment in a Medicare Advantage plan. Because beneficiaries are generally limited to changing their prescription drug coverage during the Annual Coordinated Election Period, MA-PD enrollees who want to return to Original Medicare during the Open Enrollment Period have a Part D Special Enrollment Period that allows them to make one enrollment into a PDP.

An overview of the different plan types.

Local HMOs and PPOs contract with network providers to deliver Medicare benefits. In 2008, 68% of all HMO and local PPO plans also offered Part D drug benefits. These local HMO and PPO plans account for 64% and 7% of total MA enrollment respectively.
Private Fee-for-Service plans (PFFS) are designed to allow open access to providers. PFFS plans are not required to establish provider networks, report quality measures, or have Medicare review and negotiate bids. The Medicare Improvements for Patients and Providers Act requires Private Fee-for-Service plans to comply with new quality reporting requirements and, beginning in 2011, to form provider networks in certain counties. From July 2006 to July 2008, PFFS enrollment nearly tripled from 765,000 enrollees to 2.3 million (22% of total MA enrollment).
Regional PPOs were established under the MMA to provide rural beneficiaries greater access to MA plans, with a $10 billion “stabilization fund” to encourage entry of regional PPOs. This fund was virtually eliminated under the MIPPA. In 2008, regional PPOs are available in all but five of the 26 MA regions but account for only 3% of all MA enrollees.
Medical savings account plans (MSAs) combine a high deductible health plan with an MSA into which Medicare makes annual deposits on behalf of enrollees. Beneficiaries draw from these funds to pay for qualified health care expenses until they meet a deductible (ranging from $2,500 to $5,100 in 2008), at which point the plan pays for all Medicare-covered services. In 2008, MSA plans have only 3,529 MA enrollees.

Special Needs Plans (SNPs), mainly HMOs, are restricted to beneficiaries who are dually eligible for Medicare and Medicaid, live in long-term care institutions, or have certain severe and disabling conditions. The number of SNPs increased from 125 in 2005 to 769 in 2008, with 1.2 million enrollees as of July 2008, mainly dual eligibles. The MIPPA reauthorized SNPs through 2010, but prohibits the entry of new SNPs until then.
Other plan types, including cost, HCPP, PACE contracts, demonstrations and pilots, account for 4% of MA enrollment.

For more Information on how to enroll in a California Medicare Advantage Plan call Matt Lockard at 1-866-861-0477.

When it comes to Medicare, it’s important that you know both sides of the story, and understand the advantages and disadvantages of relying solely on Medicare to provide for your health care needs. Though Medicare by itself covers many health care costs, there are many medical services that Medicare does not cover. This point is clearly made in the “Guide to Health Insurance for People with Medicare,” which is published yearly by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services. As the guidebook suggests, there are health care costs that Medicare either does not pay in full or does not pay at all. If you need or want services not covered by Medicare, you must pay the bill. To help fill the gaps in your Medicare coverage, you have the option of buying supplemental insurance policies known as “Medigap” plans. Supplement plans help pay the bills Medicare does not, and provide you with protection from the ever-increasing gaps in Medicare.
For the pre-65 Medicare beneficiary there are certain guidelines and timeframes you need to follow in order the get a health insurance policy issued. For a Medicare Supplement plan acceptance of your application is guaranteed if you are under age 65 and apply within six (6) months of your initial enrollment in Part B of Medicare. You must already be enrolled in both Parts A and B of Medicare to apply for these plans. If you have missed the enrollment period you will have to wait until November 15th and apply for a Medicare Advantage Plan.

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
So, if you are under 65 and have both parts A and B of Medicare, you can get good affordable California health insurance. We just need to follow a few rules and timelines.

By definition a “supplement” is something that backs up, tops up or makes better another thing, item, situation or in the case of this article, Original Medicare. Medicare Supplement insurance policies are sold by private insurance companies and “supplement” original Medicare.

Original Medicare was not designed to cover you 100%. There are gaps in the original Medicare and these “gap” policies help fill those out of pocket medical expenses you would otherwise pay yourself.

Original Medicare and Medicare Supplement/Medigap policies work in concert to pay health care costs. Medigap policies are all standardized and have certain specific benefits. That doesn’t mean you can’t choose benefits to suit your situation, because you will have many choices. In fact you have the option to choose from 10 different plans – Plans A through J.

Without confusing the issue too much, each plan has a different set of basic and extra benefits. You can come pretty close to tailoring a plan to your medical needs by talking things over with a health insurance agent. Talking to an agent is free, and many times can save you money by pointing you in the right direction for better coverage for a lower price.

Health insurance and Medicare contracts must follow state and federal laws. This is important, it means you are protected. It makes sense then that Medicare Supplement/ Medigap policies must also follow laws.

When you’re talking to your health insurance broker, compare the different Medigap plans. Once you have found a plan that suites your needs, compare the price of that plan with all the carriers in your state. You will find that the same plan has different prices from carrier to carrier. It doesn’t matter which plan you choose, they are the same for all insurance companies. i.e. A Medicare Supplement “F” Plan is a Medicare Supplement “F” Plan wherever you go and whatever carrier you choose.

However, having said that, each insurance company makes a decision about which Medigap policies it will sell. This is another good reason to talk to a qualified local health insurance broker who knows his stuff.

If you are considering a Medigap policy, you will need to have both Medicare Parts A and B. If you go with Medigap, you will be paying a premium for the Medigap policy on top of the cost of Part “B”. If you are applying for coverage with your spouse, they must have their own Part A and B as well.

Although it might seem confusing and time consuming to pick and choose plans that suit your circumstances, with the help of a qualified health insurance broker, it will make things a lot easier.