Medicare Made Easy

Welcome!Thank you for downloading my “Medicare Made Easy Kit.” I hope you find it informative and easy to use. I find that educating people about Medicare is the easiest way to ease their fears and frustrations with the Medicare system. Medicare is complex, and without the right guidance and support, it can become stressful and potentially expensive, both of which are easily avoidable.

“You give everything away for free, how do you make money?”

Great question. When I help clients apply for a Medicare plan, I’m compensated by the insurance carrier. My clients never pay more to have me help them, and I’m full service at no cost.

Even after reading through all this, most people elect to have me help them with their Medicare. I often meet my clients at my office or in the comfort of their own home (yes, I make free house-calls), and finish everything there is to do in less than one hour. I handle all the paperwork and together we find the perfect plan for them out of all the options in the area.

If you want my help, just let me know. I look forward to hearing from you.

Enjoy!

Certified And Authorized To Sell

AetnaAnthem Blue CrossBlue ShieldCare 1stCignaContinental LifeCoventryEasy ChoiceFirst HealthGerberHealth Net HumanaMutual of OmahaSecure HorizonsSCANSentinalSilver ScriptStonebridgeUnited AmericanUnited Health CareWellCare

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2018 Medicare Mastermind. All Rights Reserved

6 Expensive Medicare Mistakes...and how to avoid them!

Falling Into The Doughnut HoleIf you take prescription medications, all Medicare Prescription Drug Plans have a “doughnut hole.” This hole is essentially when a Medicare recipient runs out of drug benefits during the year. This happens when a client uses more than $3,750 worth of drug benefits (2018 limits) in a calendar year. Once the limit is reached, coverage decreases to about 44% of the retail price of the drug. This can be extremely costly, as the price of medications continue to increase for brand name drugs (those with no generic alternative). Once you’re in the doughnut hole, the only way to get out of it is to spend $5,000 in out of pocket expenses. Once you have spent $5,000 on prescrip-tion medications, you qualify for “Catastrophic Coverage” in which your drug cost is only $3.85 per bottle or 5% of the retail price, whichever is higher. There are legal and ethical ways to avoid the doughnut hole, please call me as the solution is too complex to explain here. By 2020, Medicare plans to close the doughnut hole completely, but until then, watch out!

Under Utilizing BenefitsMedicare Advantage plans offer some amazing benefits over and above what you can get using Original Medicare or MediCaid. But even on Medicare, you are entitled to many preventative services at no cost. These include annual wellness visits, mammograms, PSA screenings and many other vital screenings. Planning your yearly check-ups will eliminate any need to visit the doctor on multiple occasions, saving you money. The biggest under utilization of benefits happens with Medicare Advantage plans. Many Advantage Part C plans include a free gym membership. Be sure to utilize these benefits or the plan may simply remove them next year. Other benefits found in Medicare Advantage plans include but are not limited to: credits for over the counter products, free preventative dental plans, free transportation, eye exams, chiropractors, accupuncture, etc. Understanding and utilizing all of these “perks” each year will save you $1,000’s in costs, do not let them go to waste.

Not Shopping AroundI’m surprised that more clients don’t shop around for the best priced Medicare Supplement & Advantage plans. I offer a wide variety of insurance carriers and plans and notice prices change each year. The biggest mistake is simply not shopping around once or twice per year (to see if a competing plan is offering more perks or lower rates). If you’re a fan of Mediare Supplemental Plans (Medigap insurance), I find that Plan F or G is the most comprehensive and most popular. The fact is, all the plans I represent offer the SAME EXACT coverage for Plan F or G, but with widely different rates. My advice is to pick the least expensive Medicare Supplement plan you can find as most carriers are large, nationwide companies with solid financials. It pays to shop around, and I’m a one-stop shop for Medicare plans. Call me for a free consultation.

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Going Out Of NetworkOriginal Medicare has a network of providers (doctors) that accept Medicare as a form of pay-ment. The Government pays 80% of the bill, you pay the remaining 20%. If you decide to purchase a Medicare Supplement Plan (medigap insurance covers the 20%), you will still need to use a Dr. that accepts Medicare. The majority of Medicare Advantage plans have networks, too. If you decide to go outside of these networks, you could be liable for up to 100% of costs. Some Medicare Advantage plans have a PPO, Point Of Sale (POS) or a Private Fee For Service (PFFS - Original Medicare is a PFFS) structure, that allows you to go outside of the network, but you may pay higher costs to do so. Be sure you stay within your plans’ network if you’re with a Medicare Advantage plan, or use a doctor that takes original Medicare if you purchase a Medicare Supplemental Plan. Remember, your doctor is not required to take original Medicare, and changes occur each year.

Enrolling Late For Part BYour initial enrollment period (IEP) to sign up for Medicare Part B (Doctors) is seven months: 3 months prior to your birth month, and up to 3 months after you turn 65. Your IEP is typically when you turn 65 (unless you have credible health coverage from an employer or VA benefits, then your IEP is a 63 day window after loss of coverage at any age). You are responsible to call or visit your local Social Security Office (1-800-772-1213) to sign up for Part B. There is a monthly premium for Part B based on your income level. If you fail to enroll during your IEP, you will be penalized 10% of the monthly premium for each 12-month period in which you were not enrolled and you are not allowed to sign up for Part B until the first quarter of each year (January 1st to March 31st). If you sign up during this “late enrollment period”, your effective date of coverage will not be until July 1st. This means you do NOT have doctor coverage until July 1st under this late enrollment exam-ple. How much is the penalty? As an example for 2018, if you missed the original enrollment period, you would pay $147 per month vs. the common monthly premium of just $134 per month.

Enrolling Late For Part DPart D is the Prescription Drug Program (PDP). Since 2006, it has been a requirement that all Medicare recipients have credible drug coverage. Without credible coverage, you face a penalty of 1% of the national monthly PDP premium (which is about $.38 cents), for EACH MONTH you’re not enrolled in a Medicare Part D plan, or lack credible drug coverage elsewhere, like a ex-employer’s Union plan or VA Benefits. Example: If you turn 65, and fail to enroll in a PDP plan by the end of your Initial Enrollment Period, and go 10 months without coverage, you would pay $3.80 in month 11 when you finally obtain coverage. And you will pay this $3.80 penalty each month for the rest of your life (for as long as you have Medicare Part D, either as a stand-alone PDP or through a Medicare Advantage plan).

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2018 Medicare Mastermind. All Rights Reserved

6 Expensive Medicare Mistakes...and how to avoid them!

HINT: Be sure to ask about specific services you currently need, such as home heath aids, chiropractic services, durable medical equipment (like canes or walkers), dental, vision or gym membership benefits. Plans may vary greatly by specific coverage and extra benefits.

Which company’s plans are you authorized to sell?

What plans are available in my county?

What plans do I qualify for?

How much will I have to pay for premiums, deductibles, doctor visits or hospital stays?

Will my current doctors accept the coverage? If not, are there doctors near me who will?

Will I have to choose hospital and health care providers from a network?

Will I need referrals to visit specialists?

Is there a yearly limit on out-of-pocket costs?

Will the plan cover me if I get sick while traveling in another state?

What will my prescription drugs cost?

Are my drugs on the plan's drug list (or formulary)?

Does the plan include the pharmacies I currently use?

Can I get my prescriptions through the mail?

Does the plan have a 24-hour customer service line?

When does my coverage start?

What payment options does the plan offer to pay my premiums?

When can I change plans if I don’t like what I’ve chosen?

17 “Must Ask” Questions Before Choosing A Medicare Plan

2018 Medicare Mastermind. All Rights Reserved

Critical Deadlines You Simply Cannot Afford To MissMedicare has multiple dates and deadlines that you must be aware of and adhere to. We track these each year, notate any changes and advise our clients when appropriate. As your advisors, we’ll always track yearly Medicare changes and ensure you have the latest information required to make an informed decision.

What’s Your Situation?

Turning 65 Losing Insurance At Work

On Medicare Now

Permanently Disabled(at any age)

Have Medicare And Medi-CAL

Receive Help With Your Drug Costs

You must enroll into Medicare Part B within a 7 month window (3 months prior to and up to 3 months after your 65th birth month). You have up to 3 months after Part B goes effective to sign up for a Part C or Part D plan. Failure to enroll into Part B and D may trigger a penalty. You have up to 6 months after Part B goes effective to sign up for a Medicare Supplement Plan with no medical underwriting. Call Social Security at 1-800-772-1213 to enroll.

If You Have Part B AlreadyYou have 63 days from the day you lose work coverage to enroll into any type of Medicare plan.If You Don’t Have Part BYou can enroll at anytime while you’re still working and you have up to 8 months after your work insurance ends to enroll into Parts A and/or B without penalty. Cobra does not count as Credible Coverage to avoid enrolling into Parts A and/or B.

You can change your Medicare Supplement plan at anytime, once per month if you want. Some states offer the Birthday rule, most do not. To change your Part C Advantage Plan or Part D Drug Plan, you must have a Special Election Period (SEP) to do so, or you must wait for the Annual Enrollment Period (AEP) from October 15th to December 7th. Plan changes during AEP start on January 1st of the following year.

Once deemed Permanently Disabled, you will typically receive Medicare benefits starting in the 25th month. This varies by disability. Those with ALS receive Medicare benefits the same month your disability benefits begin. Contact Social Security at 1-800-772-1213 to discuss your specific situation. You do not need to be 65 or older to receive Medicare benefits when permanently disabled.

As long as you qualify for Medicare and any form of Medicaid, you can change your Medicare plan at anytime throughout the year. To qualify, you must be low-income with less than $2,000 in cash assets for single people, and less than $3,000 cash assets for married couples. You must earn less than $1,300 per month for singles, and less than $1,700 per month for married couples.

If you have a Low Income Subsidy (LIS) for Medicare Part D, you can change your Medicare plan at anytime throughout the year. To qualify, you must be low-income with less than $2,000 in cash assets for single people, and less than $3,000 cash assets for married couples. You must earn less than $1,500 per month for singles, and less than $2,000 per month for married couples.

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*NOTE: Figures listed here for Medicaid and LIS are estimates only. I encourage anyone having trouble

paying for their premiums or medications to apply to both Medicaid and the LIS program.

Call Health & Human Services to apply: (866) 262-9881

2018 Medicare Mastermind. All Rights Reserved

Medicare Critical Dates & Deadlines

Important Dates To Know

The only reason for AEP is to allow those with a Medicare Part C or Medicare Part D plan to change those plans. It also allows those that don’t have a plan, to finally enroll into a Part C or Part D plan. All applications made during AEP take effect on January 1st.

Annual Enrollment Period (AEP)October 15th - December 7th

During this period, you are allowed to drop your Medi-care Advantage Plan (Part C) to enroll back into Original Medicare. You may also enroll into a Part D Prescription Drug Plan during this time. You can also enroll into a Supplement Plan, but since this is not considered a “Guaranteed Issue” period, your application will be fully underwritten and you can be denied coverage. HINT: Apply for the Supplement first, see if you are approved, then drop your Part C plan. This way, you won’t be left without some type of coverage.

Annual Disenrollment PeriodJanuary 1st - February 14th

For anyone that missed an opportunity to enroll into Medicare Part B, this is the only time they can enroll. Enrolling during this time will give you Part B, but it will not take effect until July 1st of the same year. If you enroll late, be prepared to pay a 10% penalty over the current Part B premium for each 12 month period you did not have Part B, or some other type of creditable coverage.

This enrollment period is not for people who had “credible coverage” elsewhere, and may be losing or giving up those benefits. In your case, you would sign up for Part B under a “Special Enrollment Period” (SEP). See the SEP box below.

Part B Enrollment PeriodJanuary 1st - March 31st

There are dozens of reasons that would trigger a special enrollment period for applying for Part B, or for changing or adding a Medicare Plan. The most common would be losing workplace health insurance. Call me to discuss your situation. See some of the other reasons to the right.

Special Enrollment Period (SEP)Year Round - Time Frames Vary

Most don’t realize that you can apply for a Medicare Supplement plan at anytime, there is no “enrollment” period. Even those with a plan can try to reduce their monthly premium by shopping around. We offer this service for free, but here’s the catch:

If you apply outside of a “guaranteed issue” period, your application will be reviewed by the underwriting depart-ment and you can be denied due to health history. We offer plans that DO NOT ask any questions about your current Medication usage, and have a 98% acceptance rate, so we can get you approved in most situations.

Supplement Medigap Insurance EnrollmentYear Round - Every Month

SEP Examples:APPLYING FOR PART B - at anytime when you’re covered at work (and over 65), within 8 months after you lose or voluntarily give up coverage at work, in the 25th month after being diagnosed as permanently disabled.

CHANGING YOUR ADVANTAGE PART C or D PLANS - if you’re on Medicare & Medicaid, during a long-term care stay longer than 90+ days, within 63 days of being discharged from a long-term care stay, within 63 days of moving from a different county as long as the same plan does not exist in the new county, if you’re eligible for a Part D Low Income Subsidy (LIS) from the state, if your current plan ends their contract in your county or goes out of business, if your current plan lied or misled you, returning from living abroad, losing Medicaid or your LIS, leaving a PACE program, enrolled in a Special Needs Plan (SNP). There are others, please call for details about your situation.

2018 Medicare Mastermind. All Rights Reserved

Money Saving List Local Plan Price Comparison

Supplemental InsuranceMedicare Advantage PlansPrescription Drug PlansMedicaid Dual Eligible PlansMedicaid Special Needs Plans

Rates for a non-smoker in San Diego County. Rates are subject to change and are fixed by law. Not all applicants

will qualify. Call for details and updtaed rates.Not affiliated with any government agency.

Rates & Premiums are in addition to your Part B premiums.

Supplement Plan F

65 66 67686970

717273747580

$131$135$145$149$155$161

$167$174$181$188$195$227

AGE AGEMonthly Monthly

Medicare Advantage PlansLowest Priced HMO: $0 Monthly Premiums + Co-paysLowest Priced PPO: $74 Monthly Premiums + Co-pays

Prescription Drug PlansLowest Priced PDP: $19.70 Monthly Premiums + Co-pays + $405 Deductible for Tier 3 or higher medications.

Medicaid Dual Eligible PlansLowest Priced HMO: $0 With No Share Of Costs Must have no share of costs through Medicaid to qualifyPrescription drug costs based on low income subsidy level

Your Medicare options are listed above. Each type of plan has its own positives and negatives. I can help you determine which plan to select based on your: Lifestyle Budget Doctor & Hospital choices Medications Desired Extra Benefits

The Medicare Supplement rates to the right are updated bi-monthly and reflect the lowest available rates from 18 different insurance companies in California. For the most accurate quote, please call or email.

DID YOU KNOW?You can change your Medicare Supplement plan at anytime throughout the year. Your application will be fully underwritten, and some companies have a 98% acceptance rate! Concerned about being denied? Use the “Birthday Rule” to avoid any insurance underwriting. This means you cannot be denied due to your health history. Click below for more details about how this Birthday Rule works.

Please Call For Updated Rates: 888-555-5555

Lowest Current Rates

2018 Medicare Mastermind. All Rights Reserved