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Medigap Plans: Bridging the Gaps in Medicare Coverage

Medicare is an invaluable resource for millions of Americans. However, even with its comprehensive coverage, there are gaps and out-of-pocket costs that can catch beneficiaries off guard. That’s where Medigap plans come into play—filling in those gaps to provide greater financial security and peace of mind.

Medicare is comprised of Part A (hospital insurance) and Part B (medical insurance). While these cover a wide range of medical services, they don’t cover everything. Beneficiaries are often left with copayments, deductibles, and coinsurance, which can add up quickly, especially in the case of a serious illness or hospital stay. This is where Medigap, or Medicare Supplement Insurance, steps in.

What is Medigap? 

Medigap plans are sold by private insurance companies and are designed to complement and enhance your existing Medicare coverage. These plans help cover the costs that original Medicare doesn’t, such as copayments, deductibles, and coinsurance. By bridging these gaps in coverage, Medigap provides beneficiaries with financial security, enabling them to better manage their healthcare expenses.

There are various Medigap plans to choose from, labeled with letters (A through N), each offering a different set of benefits. Plan F, for example, provides the most comprehensive coverage, covering almost all out-of-pocket costs, while Plan A offers basic coverage. This variety allows individuals to select a plan that aligns with their healthcare needs and budget.

Why choose a Medigap plan? 

One notable advantage of Medigap plans is the freedom to choose any doctor or specialist who accepts Medicare. This flexibility in healthcare provider selection is especially important for individuals who have specific healthcare providers they trust and prefer.

It’s important to note that Medigap plans don’t cover prescription drugs. For prescription drug coverage, beneficiaries need to enroll in a standalone Medicare Part D prescription drug plan. Understanding the intricacies of Medicare and Medigap plans can be overwhelming, but professional assistance is available to help individuals navigate the options and make informed decisions based on their unique circumstances.

Medigap plans play a crucial role in the healthcare security of Medicare beneficiaries by covering the gaps in original Medicare coverage. These plans provide financial relief and peace of mind, allowing individuals to focus on their health and well-being without being burdened by unexpected medical expenses. If you’re a Medicare beneficiary, exploring Medigap options can be a smart step toward securing comprehensive healthcare coverage.

Navigating Medicare Options for Chronic Conditions

Retirement ushers in a golden era of relaxation and leisure, but it can also introduce health challenges, especially if chronic conditions are part of your life. Thankfully, Medicare, the federal health insurance program for individuals aged 65 and older, emerges as a crucial ally in managing these conditions. Let’s explore how you can skillfully harness Medicare options to effectively navigate chronic conditions in your retirement years.

Secure Enrollment in Medicare Parts A and B

The Medicare landscape comprises several parts, with Parts A and B serving as its fundamental pillars. Part A caters to hospital stays, skilled nursing facility care, and certain home health services, while Part B encompasses doctor’s visits, outpatient care, preventive services, and medical equipment. Enrolling in both Parts A and B equips you with comprehensive healthcare coverage, including critical services for managing chronic conditions.

Delve into the World of Medicare Advantage Plans

Medicare Advantage Plans, commonly referred to as Part C, offer an enticing alternative to Original Medicare (Parts A and B). These plans, presented by private insurance companies approved by Medicare, often extend beyond the basics, incorporating perks like prescription drug coverage (Part D), dental, vision, and hearing services. Some Medicare Advantage plans go the extra mile by including disease management programs and wellness options meticulously designed for individuals dealing with chronic conditions.

Ponder over Part D Prescription Drug Plans

If your chronic conditions demand continuous medication, enrolling in a Medicare Part D Prescription Drug Plan becomes an indispensable step. These plans defray the expenses associated with prescription drugs, effectively lightening the financial burden that often accompanies chronic illness management. Ensuring that your chosen plan covers your specific medications at an affordable rate is essential.

Embrace the Benefits of Medigap Policies

Medigap, or Medicare Supplement Insurance, steps in to fill the gaps left by Original Medicare. These policies cover copayments, deductibles, and various out-of-pocket expenses. For those frequently requiring medical services due to chronic conditions, a Medigap policy serves as a financial lifeline.

Leverage Preventive Services

Medicare extends a helping hand with a plethora of preventive services, including screenings, vaccinations, and counseling. These services are strategically crafted to assist in managing chronic conditions and averting further health complications. The icing on the cake? They typically come at no extra cost when administered by healthcare professionals who accept Medicare assignment.

Consider the Benefits of a Medicare Special Needs Plan

A Medicare Special Needs Plan (SNP) is a specialized Medicare Advantage plan tailored to cater to individuals with specific medical conditions, such as chronic illnesses or disabilities. SNPs customize their coverage, provider networks, and benefits to address the unique requirements of these patients. This specialized approach ensures comprehensive care, access to specialists, and tailored treatments, ultimately enhancing healthcare outcomes and quality of life.

Forge Strong Bonds with Healthcare Providers

Seeking healthcare providers well-versed in managing chronic conditions is paramount. Building robust relationships with your healthcare team opens the door to enhanced care coordination, personalized treatment plans, and improved health outcomes. To make the most of your coverage, ensure your healthcare providers accept Medicare.

Stay Well-Informed

Medicare is not a static entity; its regulations and coverage options evolve over time. Stay vigilant by keeping yourself informed about any updates or changes to your Medicare plan. Regularly reviewing your coverage ensures it remains in sync with your evolving healthcare needs.

Effectively managing chronic conditions during your retirement journey necessitates a well-crafted healthcare strategy. By enrolling in the appropriate Medicare plans and maintaining a proactive stance towards your health, you can savor a fulfilling retirement while capably steering the course of chronic condition management. Always remember that free assistance is at your disposal when it comes to reviewing the myriad of Medicare plans available. Reach out, and let us help you navigate your options in preparation for Medicare enrollment.

How Do Health Insurance Subsidies in California Work?

Healthcare costs can be a significant burden for many Californians, but based on ACA regulations the state offers a lifeline in the form of health insurance subsidies. These subsidies aim to make health coverage more affordable, ensuring that individuals and families have access to the medical care they need.

1. Covered California: The Gateway to Subsidies. Covered California is the state’s health insurance marketplace, established under the Affordable Care Act (ACA). It serves as the platform through which eligible Californians can enroll in health insurance plans and receive subsidies. These subsidies are designed to reduce monthly premiums and, in some cases, out-of-pocket costs.

2. Determining Eligibility. Eligibility for health insurance subsidies in California is primarily determined by income and family size. The Federal Poverty Level (FPL) is used as a reference point. Individuals and families with incomes between 138% and 400% of the FPL may qualify for subsidies.

3. Types of Subsidies. There are two main types of subsidies available through Covered California:

  • Premium Assistance: Also known as Advanced Premium Tax Credits (APTC), this subsidy helps lower monthly premium costs. The amount you qualify for depends on your income, family size, and the cost of plans in your area.
  • Cost-Sharing Reductions: If your income falls within a certain range (138% to 250% of the FPL), you may also be eligible for cost-sharing reductions. These reductions lower your out-of-pocket expenses, such as deductibles, copayments, and coinsurance.

4. How to Apply. To apply for health insurance subsidies, you need to enroll in a health plan through Covered California during the open enrollment period. You can apply online, over the phone, or with the help of certified enrollment counselors and insurance agents.

5. Benefit of Subsidies. Health insurance subsidies provide tangible benefits to Californians:

  • Affordability: Subsidies can significantly lower your monthly premium, making health coverage more affordable and accessible.
  • Choice: Covered California offers a range of health plans, allowing you to choose the one that best fits your needs and budget.
  • Peace of Mind: With health coverage, you can access preventive care, medical treatments, and prescription medications without worrying about exorbitant costs.

6. Changes in Circumstances. It’s important to report any changes in your circumstances that may affect your eligibility for subsidies. Changes in income, family size, or even location can impact the level of assistance you receive.

In conclusion, health insurance subsidies in California provide a vital lifeline for individuals and families seeking quality healthcare coverage without straining their finances. By understanding the eligibility criteria, types of subsidies, and application process, you can take advantage of this valuable support system offered by Covered California. Remember, enrolling in a health plan with subsidies not only protects your health but also safeguards your financial well-being.

Preparing for AEP: Addressing Gaps in Your Medicare Coverage

As the Annual Enrollment Period (AEP) looms on the horizon, it’s time for Medicare beneficiaries to delve into their current coverage. While Medicare offers essential healthcare benefits, it might not encompass all your individual medical requirements. With the approach of AEP, it’s prudent to seek out coverage gaps and potentially discover a plan that aligns more seamlessly with your needs.

Begin by scrutinizing your prescription drug coverage. Original Medicare doesn’t encompass prescription drugs, leaving a gap that can lead to hefty medication expenses. To bridge this void, consider Medicare Part D, which offers standalone prescription drug plans. Alternatively, many Medicare Advantage plans integrate Part D into their coverage. Make certain to assess each plan’s formulary—the roster of covered medications—to ascertain whether your regular prescriptions are included.

Turn your attention to dental and vision care, vital components of overall well-being. Original Medicare neglects these aspects, yet their significance is undeniable. Numerous Medicare Advantage plans encompass dental and vision benefits, rendering them especially appealing for those seeking comprehensive healthcare coverage.

Factor in potential long-term care costs. Original Medicare excludes long-term care services, like nursing home care and assistance with daily activities. For this void, explore long-term care insurance or specific Medicare Advantage plans with limited long-term care benefits.

Does your policy extend to hearing aids? Medicare doesn’t cater to hearing aids, which play a pivotal role in communication and quality of life. Several Medicare Advantage plans might offer partial hearing aid coverage, enhancing accessibility for those in need.

Examine your existing health status and diagnoses. Beyond Original Medicare and Medicare Advantage plans, Special Needs Plans are available to those facing specific health conditions. These tailored plans revolve around the needs of individuals, streamlining care coordination.

Medicare Advantage plans and Medigap policies stand as supplements to original Medicare, furnishing additional coverage for services beyond Parts A and B. Medicare Advantage plans, extended by private insurance companies, often amalgamate hospital, medical, and prescription drug coverage. Moreover, they may encompass extras like dental, vision, and hearing care.

Conversely, Medigap policies work alongside original Medicare, offsetting out-of-pocket expenses like copayments, coinsurance, and deductibles. This relief can alleviate the financial strain associated with medical services, providing a sense of security.

Reach out to us to arrange a consultation in anticipation of the Annual Election Period. We’re equipped to discuss these alternatives and assist you in identifying plans that seamlessly align with your needs. AEP marks an opportunity to fine-tune your healthcare coverage, ensuring that you journey forward with confidence and comprehensive support.

Medicare Enrollment Opens in Less Than Three Months

Some of you might love your Medicare plan, while others feel stuck with a plan that isn’t right for you. And a few of you might feel uncertain; your plan works okay, but you wonder if there’s a better deal out there. In less than three months, all of you get a chance to investigate your options and make changes during the Medicare Annual Enrollment Period (AEP). Here’s what you need to know now.

Research now. Take a look at your medical bills for the year, and determine if your out-of-pocket costs seem reasonable. Make a list of your current medications so that you can check plan formularies (lists of covered drugs) to keep your monthly prescription spending in line with your budget.

You can make a variety of changes, such as:

  • Switch from one Medicare Advantage plan to another
  • Move from Original Medicare to Medicare Advantage
  • Drop your Medicare Advantage plan and go back to Original Medicare
  • Change your Part D (prescription) plan or add one, if you don’t already have Part D

You can change plans as many times as you want. If you enroll in a plan during AEP and then decide it’s not right for you, you aren’t stuck with it. Changes aren’t made permanent for the coverage year until December 7, so you can always change your mind at any time during the enrollment period.

Some of you get a second chance. If you enroll in a Medicare Advantage plan during the Annual Election period and then decide it’s not right for you, you can switch to a different Advantage plan or drop it and return to Original Medicare during the Medicare Open Enrollment from January 1 through March 31. So if you want to try out a Medicare Advantage plan, let’s discuss your options during AEP this October.

Even those who are happy with their plans should investigate their options. You might feel as though your plan works well for you, but you won’t know if there’s an even better deal out there unless you engage in some comparison shopping. Some plans, particularly Medicare Advantage plans, roll a number of extra benefits into the network (such as dental or vision care, prescription plans, or even perks like discounted gym memberships). Call us when AEP begins October 15, and we will help you sort through the different plans available to you.

Again, AEP begins October 15 and runs through December 7, so you have plenty of time. But if you start evaluating your medical expenses and preferences now, you will be ready to select the best plan for your situation this fall.

Will I Be Penalized if I Don’t Enroll in Medicare?

Most of you looking forward to eventual retirement are aware that you can sign up for Medicare at age 65. But did you know that enrolling in Medicare is actually a requirement? And if you don’t sign up, you could be penalized, depending on the circumstances?

A quick read of the rules would lead you to believe that everyone is required to enroll in Medicare when they turn 65, but that’s not entirely true. There is one exception to this rule: If you’re still covered by an employer’s group healthcare plan, either through your own employment or your spouse’s, and that employer has more than 20 employees, then you don’t have to enroll yet.

In that case, you have creditable coverage, and you won’t have to enroll in Medicare until you separate from the employer or otherwise no longer have that healthcare plan.  However, you should note that Medicare does not consider COBRA creditable coverage.  If you are over 65 and losing employer group coverage, you must enroll into Medicare withing 60 days of losing coverage.

On the other hand, you have the option to enroll and use Medicare as secondary coverage. This option might benefit you, depending upon your usual out-of-pocket expenses and how they stack up to Medicare premiums and coverage.

If you’re still employed, but the employer has fewer than 20 employees, then you do have to sign up for a Medicare plan.

And of course, everyone else – both retirees or those still working who lack a healthcare plan – must enroll in Medicare at age 65.

So, what’s the “penalty” for failing to enroll on time? Technically, the penalty doesn’t impact you until you do enroll at some later date. But at that point, you will be charged a 10 percent penalty, added to your regular premiums, for each year that you delayed enrollment. If you delay by several years, you’re looking at significantly higher premiums for the rest of your life.

Before making a decision about Medicare enrollment, call us to speak with one of our insurance brokers. We can help you determine if Medicare enrollment is required in your case. If you’re not required to enroll, we can help you decide if utilizing Medicare as secondary insurance might be a good idea for you. And if you are required to enroll, we can help you choose a plan and fulfill that requirement in a timely manner, so that you avoid the possibility of a penalty.

What to Do About Healthcare if You Retire Before Age 65

An early retirement sounds like a dream come true for many people. For others, it’s simply a necessity for one reason or another. But if you’re due to retire before age 65, or simply thinking about it, there is one crucial factor to consider: What will you do about healthcare if you retire before the age of Medicare eligibility?

If you find yourself in this predicament, or heading in that direction, you do have options.

Ask about COBRA. If your employer is COBRA-eligible, you can continue enrollment in their group healthcare plan for 18 months after your employment with them ends. And in certain situations, that coverage can extend to 36 months. However, in many cases the COBRA coverage is more expensive, because you’re now paying the full premium without an employer contribution. So do estimate the costs before making a decision.

Join your spouse’s healthcare plan. If your spouse is still working for an employer that offers healthcare benefits, you could simply join their plan. Be aware that their plan might not offer coverage equal to your old one, but there can be various ways to deal with that. A health savings plan can help (more on that later) or you might be able to enroll in additional supplementary policies such as a dental or vision care plan.

Shop for a plan through Covered California. Our statewide health insurance exchange offers a plethora of options for healthcare coverage. And depending upon your income and household size, you might qualify for a subsidy to help with the cost of your premiums. If you plan to relocate in retirement, check with that state’s exchange or shop on the federal exchange, if applicable.

Enroll in a health savings account (preferably now). If you’re enrolled in a low-premium, high-deductible plan now, you can go ahead and set up a health savings account. This account allows you to save pre-tax dollars in an account to be used toward qualified healthcare expenses. And if you don’t use all of your funds during any particular calendar year, the money rolls over to subsequent years. In this way, a health savings account can save you money now, while also serving as a retirement savings vehicle to be used toward healthcare costs in the future.

If you’re considering an early retirement, before the age of Medicare eligibility, call us to discuss your healthcare plan options first. We can help you figure out how to proceed in the most affordable way for your situation.




You Might Be Able to Enroll in Both Medicare and Medi-Cal

Once you retire and enroll in Medicare, you might be surprised to learn that you can face thousands of dollars in out-of-pocket healthcare costs each year. That can come as an unpleasant shock to those who are already living on a fixed income and are relying on Medicare to cover their medical expenses. But for some lower-income retirees, there is another option that can help.

Medi-Cal is a program separate from Medicare, but also designed to help with the cost of medical care. It’s funded by both federal and state governments. And yes, some people can qualify for both Medicare and Medi-Cal.

When Medicare doesn’t cover the cost of a service, Medi-Cal often does. Those who are “dual eligible”, meaning they are eligible to enroll in both programs, might be happy to learn that Medi-Cal can cover the cost of things such as:

  • Medicare Part B premiums
  • Medicare Part B deductibles
  • Medicare Part A deductibles (for hospital stays)
  • Medicare Part D copayments, and deductibles for covered drugs
  • Nursing home care, in facilities that accept Medicaid payment
  • Home-based and community-based supports, depending on services available in your area

In order to qualify for Medi-Cal you must meet certain income and assets tests. In some cases, you might qualify by income, but own certain assets that disqualify you. Under those circumstances it can be helpful to speak with an estate planning attorney who is experienced in helping clients qualify for Medi-Cal.

If you don’t qualify for Medi-Cal, certain other savings programs do exist. If you struggle with the cost of out-of-pocket medical bills, call us, we are licensed agents who can assist with your options.


Veterans Can Access Valuable Home Health Benefits

The Department of Veterans Affairs (VA) offers a comprehensive healthcare package to our veterans. But what many beneficiaries don’t know is that they can access home healthcare benefits through the program, through the VA’s Homemaker and Home Health Aide program (H/HHA). If you or someone you love is a veteran, you should be aware of these valuable benefits, so that you can access in-home care in the event that you ever need it.

The Homemaker and Home Health Aide program provides assistance with personal health care needs and other daily activities, by trained workers who come directly to the veteran in his/her home. The community-based program is supervised by a registered nurse, with the goal of helping veterans continue to live independently or with their family. Aside from valuable daily healthcare services, an in-home healthcare worker provides companionship and allows for respite for family members who might normally provide this care.

Each service provides for unique services, depending upon the individual’s needs. The health care services provided might include:

  • Assistance with medical equipment
  • Routine monitoring of health conditions or general health
  • Help with exercise
  • Abulating or transfers
  • Assistance with dressing, eating, toileting, and bathing, as needed

But in-home healthcare isn’t solely focued on medical assistance. Homemakers or health aides can also assist clients with tasks such as:

  • Laundry services
  • Grocery shopping and meal preparation
  • Escorting the client to appointments
  • Light housekeeping necessary to maintain a safe and clean environment for the client

Providing these services to veterans helps not only them, but also their family members or other caretakers who need respite from these daily tasks. Those who receive in-home care services often remain at home longer, and avoid the need to move into a skilled nursing facility.

To qualify for the veterans home care program, an applicant must:

  • Be enrolled in VA healthcare benefits
  • Qualify for community care services
  • Obtain a doctor’s order to receive in-home care services

For more information on this topic, contact us and we will refer to you a qualified service provider.

Watch Out for Medicare Scams

You might wonder why on Earth anyone would want to steal your Medicare number and other data. Are they planning to obtain medical services using your benefits?

That’s possible, but much less likely than other common scenarios. For one thing, all of your Medicare information can help a scam artist steal your identity, which they would then use to obtain credit cards or other resources in your name. Fraudulent companies might also bill your plan for products and services you don’t actually receive. And sometimes, actual insurance agents are to blame; unscrupulous ones do exist, and they might trick you into enrolling in a plan you didn’t want in order to gain the commission.

To protect yourself and your information, watch for these common signs of Medicare fraud.

Calls from representatives. Medicare does not employ representatives who call you to ask details about your plan, your Medicare number, or other information. If anyone calls you claiming to be a Medicare representative, hang up the phone. If you’re concerned about your plan, you can call your benefits administrator to check.

Fear-based tactics. Fear-based tactics are always a sign of either unscrupulous sales tactics or outright fraud. But just to clear up a common misconception: You won’t “lose” your benefits if you don’t make certain changes. You will be re-enrolled in your current plan year after year, unless you make a change during the Annual Election Period in the fall or Medicare Advantage Open Enrollment in January through March. Anyone who tells you otherwise is trying to force you into a change that benefits them.

Fishy rebates or refunds. If you do overpay for a service, your benefits administrator will send you a letter about it. Anyone offering you a rebate or refund over the phone is just trying to gain access to your information.

Tempting extra benefits. Insurance brokers who approach you with tempting “extra benefits” should be viewed with suspicion. This language is often used to trick you into switching your plan or enrolling in additional ones. Always ask to see a broker’s license number before doing business with them.

And of course, know that you can always call us with questions about Medicare. We pride ourselves on doing business ethically and helping our customers access the Medicare plan or plans that are right for them.


We welcome you to contact us if you need assistance
or to get a policy quote.