Do you offer free consultations & proposals to new clients?

Yes, all of my services are completely free. I am compensated by the insurance carriers only if I can improve your coverage and/or save you $$

 

Why do I need a Medicare Supplement Plan?

Standard government issued Medicare only covers 80% of your non-hospital medical expenses and none of your prescription drug costs. It also requires you to pay significant deductibles and co-pays and limits your number of covered days hospital and skilled nursing care.

 
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Why do I need a Medicare Advantage Plan?

Standard government issued Medicare only covers 80% of your non-hospital medical expenses and none of your prescription drug costs. It also requires you to pay significant deductibles and co-pays and limits your number of covered days hospital and skilled nursing care. A Medicare Advantage Plan (MA) is generally an HMO plan which substitutes for the original Medicare and covers most or all of the gaps in original Medicare and often offers extras like international travel coverage or discounted gym memberships. Most MA plans also offer Prescription Drug (PD) coverage not covered by original Medicare and are called MAPD plans.

 
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What is the LIS (Low Income Subsidy) Program and How Do I Qualify?

The LIS program (also known as Extra Help)  is designed to assist low income seniors in paying for their prescription drug costs. It offers significant discounts to seniors whose assets and income fall below levels set by the state of CA. In 2019, seniors that receive Extra Help pay no more than $3.40 for each generic/$8.50 for each brand-name covered drug. This can be a significant savings if you have non-generic prescriptions. Most will also not have to pay Part D premiums or co-pays.  If your monthly income is up to $1,581 in 2019 ($2,134 for couples) and your assets are below specified limits, you may be eligible for Extra Help. If you're already enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. If you think you might meet the LIS eligibility requirements, I can assist you in applying with relevant state agencies. 

 
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What's the difference between a Medicare Advantage Plan and a Medicare Supplement plan

A Medicare Advantage Plan (MA) is generally an HMO plan which fully substitute for your original Medicare, while Medicare Supplement plans, also called Medi-Gap only cover the gaps in original medicare.  The key difference is that most MA plans are HMO type plans, meaning that you are required to choose a primary care physician, who must give approval for you to see a specialist. You are generally restricted to using Doctors within the carriers network to get full payment for services. Medi-Gap plans are the best option if you want the freedom to see any Medicare contracted Dr. or specialist anytime and anywhere you want without a referral from a primary care physician. Medi-Gap plans don't include Prescription Drugs (PD), so you'll need to purchase a stand-alone PD plan, whereas many MA plans include a PD plan. (MAPD) Medicare Advantage (MA) plans are generally a less expensive option than a comparable Med-Supp. Policy, mainly because of the restrictions outlined above. 

 
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What is a Prescription Drug Plan and why should I have one?

Since neither Medicare supplement plans or standard Medicare Advantage Plan (MA) include prescription drug benefits, it is generally a good idea to have a Prescription Drug (PD) plan. Original Medicare allows you to purchase a Part D Medicare PD plan. Also many MA plans include a PD plan for an additional fee. (MAPD) Drug expenses can add up, so you should consider a plan that will cover your most costly meds. 

For 2019, the standard Medicare PD benefit requires the beneficiary to pay:

  • $415 deductible

  • 25% of prescription drug costs between $415 and $3,820 = $851.25

  • Part of the costs in the “Coverage Gap” -After total spending on drugs by the beneficiary reaches $3,820, the beneficiary pays for 37% of generic drug costs and 25% of brand name drugs until total spending reaches $51

 
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What Penalties Apply for Late Sign-up for Medicare Part B or Prescription Drugs? (Part D)

In most cases, if you don't sign up for Part B when you're first eligible, you'll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.

For Part D (Drug) coverage, you may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

  • A Medicare Prescription Drug Plan (Part D)

  • A Medicare Advantage Plan (Part C) (like an HMO or PPO)

  • Another Medicare health plan that offers Medicare prescription drug coverage

  • Creditable prescription drug coverage

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.