Keeping You in the Know

Health Tips and Information


Covered California Open Enrollment Is Approaching

For those of you who are already enrolled in a healthcare plan through Covered California, as well as those who wish to enroll for the first time, pay attention to this important date. On November 1, Open Enrollment begins. Now is the time to analyze your budget and ask yourself about your priorities in a healthcare plan, so that you’re ready to conduct some comparison shopping next month.

First, let’s review what you can do during Open Enrollment:

Enroll in a new plan. Those of you who are not yet covered by a healthcare plan can enroll for the first time during Open Enrollment.

Compare your current plan, and choose a different one if desired. Everyone should review their current plan to discover whether any changes will be made that affect you. For example, if your network is changing or covered drugs have been dropped from the plan’s formulary, you might wish to switch to a healthcare plan that better suits your needs.

Even those who feel satisfied with their current plan should engage in a bit of comparison. You won’t know if a better deal is out there, unless you look!

Apply for a subsidy. If you need help with the cost of your healthcare premiums, apply for a subsidy. These tax credits apply to those with incomes between 128 percent and 400 percent of the federal poverty level. A subsidy can help you to afford a healthcare plan or even upgrade into a higher tier plan that you might not otherwise choose.

Renew your subsidy. If you’re already receiving a subsidy, you should log onto the Covered California portal to update your information. Taking this step ensures that your subsidy is calculated correctly.

Enroll in Medi-Cal. Those whose annual incomes fall below 128 percent of the federal poverty level can enroll in Medi-Cal (Medicaid in California).

Open Enrollment will begin November 1, 2021, and run through January 31, 2022. However, if you wish for your new healthcare coverage to start on January 1, make sure you enroll by December 15. If you have any questions about Covered California, don’t hesitate to contact our office and we’ll be happy to assist you.

Understanding the Difference Between a Medicare Advantage Plan and a Medicare Supplement Plan

Contrary to common belief, you won’t just enroll in Medicare at 65 and then be done with it. Actually, Medicare encompasses many different parts, and there are even Medicare options offered by private insurance companies.  Putting together the right plan, or combination of plans, will help you to manage your healthcare expenses throughout retirement. Plus, each year you have the opportunity to change your Medicare plan during Medicare’s Annual Election Period.

So as you confront that maze of decisions, you will start to learn about the different types of Medicare plans out there. One common question that we hear a lot is, “What is the difference between a Medicare Advantage Plan and a Medicare Supplement Plan?”

A Medicare Advantage Plan is simply an insurance plan, offered by a private insurance company, that complies with certain standards set forth by Medicare. These plans operate based upon a network of providers and facilities, and might feel similar to the healthcare plan you enjoyed pre-retirement. They all encompass Medicare Parts A and B, and some also include Part D (prescription drug) coverage.

A Medicare Supplement Plan, or Medigap plan,  is designed for those who enroll in Original Medicare (Parts A and B) to help them manage out-of-pocket expenses. A Supplement Plan covers out-of-pocket expenses like your co-pays and deductibles, and even some uncovered services such as healthcare that you receive when traveling outside of the country. This type of plan can be a good option for those who want to stick with Original Medicare, but are worried about fluctuating out-of-pocket expenses. You cannot use a Supplement Plan with Medicare Advantage.

Hopefully that clears up the issue for you! But if you have any other questions about the different types of Medicare plans available to you, just give us a call. And remember, Medicare’s Annual Election Period begins on October 15. Get ready to make a decision about your healthcare plan for 2022.


7 Things Medicare Does Not Cover

As we plan for retirement, most of us expect that Medicare will provide for our healthcare needs. And yes, you will become eligible for Medicare when you turn 65, around the time many people choose to retire. But contrary to popular belief, Medicare will not necessarily cover everything you might need with regard to healthcare! It’s important to understand the limitations of the program, so that you can make a plan to pay for these items in some other way.

Dental. Generally speaking, Medicare does not cover dental exams and procedures. The program also does not cover dentures. However, some Medicare Advantage plans include dental coverage, and a supplemental plan might be another option for you.

Vision. Medicare will cover treatment for medical problems with your eyes, such as cataracts. But you will need to self pay for routine vision exams and corrective lenses, or look into a supplemental vision insurance program. Some Medicare Advantage plans do include this coverage, but those plans might not be available in all areas.

Cosmetic surgery. With regard to cosmetic surgery, Medicare will only cover reconstructive procedures related to an injury or illness. For elective cosmetic treatments, you’re on your own.

Podiatry. Some podiatry services are covered by Medicare, while others are not. Check your plan carefully before visiting a podiatrist, and make a plan to pay for uncovered expenses.

Hearing aids. Original Medicare will not cover hearing exams or hearing aids, but does cover medical treatments relating to the ears. Some Medicare Advantage plans do include hearing aid coverage, or you can look into one of the newly approved over-the-counter hearing aids that will soon be available.

Nursing homes. Medicare coverage for rehabilitative treatment in a facility is quite limited. If you need to move into a nursing facility in the long term, you will be responsible for that expense. Look into long-term nursing care insurance as you prepare for retirement.

Medical care received in other countries. If you plan to travel outside of the country, you might be interested to know that Medicare will not cover the cost of medical treatments received abroad. A Medigap policy can provide for this need.

In some cases, Medicare Advantage plans provide more comprehensive coverage than Original Medicare. But because each plan is different, we recommend that you work with us to identify a policy that best suits your needs. Continue to prepare for retirement, understanding that you will need to self pay for some medical services.

What You Can And Cannot Do During Medicare AEP

Medicare’s Annual Enrollment Period is rapidly approaching, and will begin on October 15. At this point you might be wondering what you can do during Medicare AEP. And on the other hand, it can be helpful to know what you cannot do, so that you understand the limitations of the program. So here’s what you need to know right now.

What you can do during Medicare Annual Enrollment Period:

  • Drop Original Medicare and enroll in a Medicare Advantage plan instead
  • Drop your Medicare Advantage plan and go back to Original Medicare
  • Compare costs of different Medicare Advantage plans to identify one that better suits your needs
  • Change from one Medicare Advantage plan to another
  • Add a Part D (prescription) plan to Original Medicare, drop a Part D plan, or switch from one Part D plan to another

If your plan provider is making changes to your current plan, they will send you an annual notice of change in the mail. Look for this notice, so that you can anticipate upcoming changes and switch plans if necessary. Even if you’re happy with your current plan, it makes sense to compare with different options to be sure you’re enrolled in the best plan for your needs and budget.

That’s pretty comprehensive. But there is one thing that you cannot do during Medicare Annual Enrollment Period: This is not the time to enroll in a Medigap plan. The Medigap Open Enrollment Period is a six-month period of time that starts when you first become eligible for Medicare. During this time, you can enroll in a Medigap plan without answering any questions about your health. Later, you can drop your Medigap plan and enroll in a new one, but you have to pass underwriting first. There are no guarantees that you will be eligible for a new or different Medigap plan outside of the original Open Enrollment window, so the time to make this important decision is during your original Open Enrollment Period.

Remember, Medicare’s Annual Enrollment Period begins October 15 and runs through December 7. Call us for more information, and we can help guide you through this process.



3 Questions to Ask About Your Medicare Plan

The Medicare Annual Election Period is approaching fast, and will begin October 15. This is your chance to review both your plan and your budget, to determine whether your current plan is the best fit for your needs.

Medicare plans are complex, and you might need assistance to determine which one suits you. But asking yourself these three questions can get you started toward making this very important decision.

Is my doctor part of my plan’s network? Medicare Advantage plans are organized around networks of providers, whereas Original Medicare and Medicare Supplement plans allow you to visit any provider that accepts Medicare.

Network coverage can sometimes change from one year to the next. So if you prefer a Medicare Advantage plan, check to be sure that your preferred facilities and doctors are covered under your plan. If not, we can help you locate a plan that does offer that coverage.

Do I need prescription drug coverage? Original Medicare doesn’t include prescription drug coverage, but you can enroll in a Part D plan to cover that need. Many Medicare Advantage plans do include Part D coverage, however. If you take prescription drugs regularly, it is likely that a Part D plan will benefit you. Check your plan’s formulary, keeping in mind that it can change each year, to determine whether it provides for your needs. Comparing several plans can help you locate the one that provides appropriate coverage.

What is my healthcare budget? How much can you afford to pay for out-of-pocket expenses like premiums, co-pays, and deductibles? Has your current plan helped you to manage expenses well, or do you prefer to shop for a plan with lower out-of-pocket costs? Numerous options are available to help you fit healthcare into your budget.

Give us a call, and we’ll help you assess your current coverage and any impeding changes to your plan that might affect you. Then, together we can compare Medicare plans to see if we can locate a better fit for both your finances and healthcare needs.

4 Things that Will Prepare You for Open Enrollment

At this point in the summer, health insurance might be the last thing you’re thinking about. But because Open Enrollment is really just a few months away, now is the time to begin evaluating satisfaction with your current plan.

Plus, due to the pandemic and increased need for healthcare coverage, Covered California is actually operating a Special Enrollment period for the duration of 2021. So if you’re dissatisfied with your current healthcare plan or still haven’t enrolled in one, you can take care of that important step right now!

Here’s what you need to know, before shopping for a healthcare plan:

Consider your location. Healthcare plans are location-based, meaning every plan isn’t offered in every location. So don’t assume that you can get the same plan that your friend 100 miles away enjoys. And since your location influences the plans offered in your area, take a look around at local providers. Decide where you prefer to receive healthcare services, and look for a plan that includes those doctors and facilities within its network.

If you’re planning a move, as many people have over the past year or so, healthcare access and plan availability should be part of your decision process.

Learn the tiers. Healthcare plans are arranged in tiers, called Bronze, Silver, Gold, and Platinum, according to coverage and out-of-pocket expenses. Bronze plans impose the lowest monthly premiums but have the highest deductibles. At the other end of the spectrum, Platinum plans charge the highest monthly premiums but have the lowest deductibles.

Don’t assume that low premiums will translate into the lowest expenditure for the year. Everyone’s needs are different, and someone who uses healthcare services frequently might be better served by a lower-deductible plan.

But if you do choose a low-premium, high-deductible plan, consider pairing it with a health savings account. This account allows you to set aside pre-tax earnings to be used toward your deductible and other out-of-pocket expenses.

Apply for subsidies. Subsidies are calculated according to your income and household size, and can help to offset the cost of your premiums. You might qualify for more than you think.

Get help. Choosing a healthcare plan is a complicated decision that will impact your finances over the next year. Call us for expert guidance, and we can help you understand all of the complexities of each plan before selecting one that best suits your needs.




An Update Regarding HRA and HSA Contribution Limits

As part of a package of benefits, employers offer health reimbursement arrangements or health savings accounts to assist employees in managing their out-of-pocket healthcare expenses. But because the cost of living, and the cost of healthcare in particular can rise over time, contribution limits to those accounts also change. Due to inflation and changing costs, here’s what we know about contribution limits to HRAs and HSAs next year.

HRAs are designed to assist employees in managing their healthcare choices and expenses. Funds can be used to cover things like COBRA premiums, disability insurance, critical illness insurance, or dental and vision insurance. This provides a valuable benefit to workers who then use the money in a way that best suits their needs. For 2022, HRA contribution limits will remain at the current level of $1,800 for the year.

However, HSA contribution limits will be changing. Health savings accounts are designed to allow employees to set aside pre-tax dollars, to cover out-of-pocket expenses for their own healthcare. These plans are paired with high-deductible, lower-premium healthcare plans, and allow for greater responsibility over one’s own healthcare choices. Since the cost of healthcare is expected to rise next year, the contribution limit for HSAs will rise to keep pace with that inflation. However, deductibles for their healthcare plans will remain the same.

Check the chart below to see how contribution limits for HSAs will change next year:

If you are an employer looking to provide your employees with the benefits package that best suits their needs, give us a call and we’d be happy to explain how these programs work.  Or, if you need help with any other aspect of your group benefits plan, just let us know.  We’re here to provide assistance.

Protect Yourself from Medicare Fraud

It can be hard to believe that anyone would want to steal your Medicare information. What are they going to do, go to the doctor and charge your plan for the bill? Well, technically that could happen. But it’s more likely that accessing your Medicare information will give a con man all the data he needs to steal your identity. From there, he can get credit cards or even take out loans in your name. Your Medicare information was just his way into your personal life.

Your Medicare number could also be used to charge fraudulent services or products that you never actually receive, funneling the payment to a fake medical products company.

Medicare fraud is unfortunately quite common for this reason. Follow these tips to protect your personal information.

Don’t give out information over the phone. Medicare will not call to enroll you, and they never ask identifying information over the phone unless you call them. If anyone calls wanting your Medicare number or other personal information, hang up the phone.

Keep your card in a secure place. If lost or stolen, someone could commit fraud with your information.

Beware of coronavirus “cures” or tests sold over the phone or online. Anyone trying to sell you a coronavirus treatment or test over the phone is a con artist trying to access your Medicare information. The FDA has approved one mail-order coronavirus test, but it is only available through your doctor.

Check your Medicare Summary Notices regularly. Report any claims that you don’t recognize, as this can be an indication that someone is using your Medicare number.

Beware of manipulative tactics. Remember that con artists often prey on fear; of coronavirus, of chronic disease, of financial setbacks, or even just the fear of missing out on a good deal. If it seems like someone is trying to make you afraid, it might be because they’re trying to get you to act without thinking logically or investigating whether they are even legitimate.

And of course, if you have questions about your Medicare plan, call your plan’s customer service line. They can help you obtain the medical services you need, safely and while protecting your information.


Why Everyone Needs an Advance Medical Directive

It’s no fun to think about, but it’s a reality for all of us. At some point we will all need some form of medical care and/or end-of-life care. You probably have some idea of your preferences, but do your spouse and family know about them? And are you confident that they would follow those wishes under duress? What if the situation becomes uncertain, or family members begin to disagree?

For those reasons and more, an advance medical directive is necessary for everyone. This document will not only protect your interests; it also shields your family members from complicated emotions and disagreements.

So, what does an advance medical directive do, exactly? In the event that you’re ever incapacitated by injury or illness, the document will direct your chosen person as to what steps you wish to be taken. There are actually three different ways that you can do this:

A living will spells out your preferences for medical care in a life-threatening situation, to both your doctors and loved ones. You can use it to instruct them on issues such as resuscitation, artificial feeding, pain relief, and end-of-life care.

A healthcare proxy is a person that you have designated to handle your medical decisions for you. It is less specific than a living will, but could also be considered more flexible. You simple choose a person that you trust, and allow them to make all of your medical decisions for you. If you go this route, make sure to have regular conversations with this person regarding your wishes.

A durable power of attorney grants the person of your choosing with the ability to act on your behalf regarding business and financial matters. This person will be able to manage your money, pay bills, file insurance claims, file for disability benefits, and perform other, similar actions.

Keep in mind that you can appoint different people to each role, in the event that you want to avoid conflicts of interest or over-burdening one person. Consider the strengths of your loved ones carefully, and fill each role accordingly.


How Do I Enroll in Medicare?

Most of us know that, at some point in the future, Medicare will provide for our health insurance needs. Typically we expect this coverage to begin around the time we retire. But if you’re like most people, you’re probably wondering, “When exactly do I enroll in Medicare? And how do I do that?” No worries; we have the answers you need.

In most cases, you will sign up for Medicare when you turn age 65. You can enroll at any point beginning three months prior to the month in which your birthday falls, during your birthday month, or for three months afterward. If you sign up before you turn 65, coverage begins on your birthday.

Don’t be late, because you can be charged a penalty in the form of higher premiums for the rest of your life.

There are some exceptions to this rule. If you’re still working, and your employer provides a group benefits plan that includes healthcare coverage, you might be able to delay your Medicare enrollment. Or, you can enroll in both, and utilize Medicare as supplementary insurance. It all depends upon the size of your employer, along with your personal preferences, so discuss this issue with your human resources department or an insurance agent familiar with Medicare.

The above rule also applies to those who are married, and whose spouse is still working and is covered by a group benefits plan.

There are two ways to enroll in Medicare. If you’ve already claimed your Social Security benefits, your enrollment in Medicare Parts A and B will be processed automatically when you turn 65. However, you still need to consult with an insurance agent if you’re interested in other forms of coverage, such as a MediGap plan, Medicare Advantage, or a prescription drug (Part D) plan.

If you’re not already drawing your Social Security benefits, you are responsible for enrolling Medicare. You can do this by visiting the Medicare website, but this isn’t always the best way to proceed. To learn more about all of the options available to you, and for personalized help in determining which plan(s) best fit your situation, work with a qualified insurance agent instead.

On that note, give us a call with your questions about Medicare. We can help you compare plans, learn the rules that apply to your situation, and select the options that work best for you.


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