Keeping You in the Know

Health Tips and Information


Understanding Medicare AEP and Medicare Advantage OEP

Medicare beneficiaries are offered different opportunities to examine their Medicare plans and make necessary changes… But these opportunities can be confusing at times. Depending upon your plan participation, you will hear about Medicare Annual Enrollment Period (AEP) and the Medicare Open Enrollment Period (OEP). Each of these events occur annually, and serve similar but somewhat different purposes for beneficiaries.

Medicare Annual Enrollment Period. From October 15 to December 7 each year, you will have the opportunity to review any upcoming alterations to your plan. You should receive notice of changes to drug formularies, premiums, coverage, and so on. And, if necessary or desired, you can respond by making the following changes:

  • Drop Medicare Advantage and return to Original Medicare
  • Move from Original Medicare to a Medicare Advantage plan
  • Switch from one Medicare Advantage plan to another
  • Make changes to Part D enrollment, such as enrolling for the first time, dropping coverage, or changing plans

Changes that you make during this time will take effect for the following plan year, on January 1. Those who don’t make changes will simply be re-enrolled into their current plan selections.

Medicare Open Enrollment Period. Those enrolled in a Medicare Advantage plan also have the opportunity to make changes, during the OEP which runs from January 1 to March 31 each year.

During this time, Medicare Advantage participants can:

  • Drop your Advantage plan and return to Original Medicare
  • Switch from one Advantage plan to another
  • Add, drop, or change your Part D plan, if you’re enrolled in a separate plan (many Advantage plans include Part D coverage automatically)

The OEP only applies to Medicare beneficiaries who are enrolled in an Advantage plan on January 1, and only one change can be made during this time. Any changes made will become permanent for the duration of the plan year.

With January 1 rapidly approaching, we urge you to contact us if you have questions about your Medicare Advantage plan. We can help you assess your options and make changes during the OEP, if necessary.




Medicare’s Annual Election Period Ends Soon

If you’re a Medicare beneficiary, take note of this important date: December 7 is the closing date of Medicare’s Annual Election Period. Unless you make desired changes to your Medicare plan by that date, your current plan will automatically renew for next year.

Why is this important? Even if you like your current Medicare plan just fine, plan administrators can and do make changes each year. Sometime prior to October 15, you should have received a notice called either Evidence of Change (EOC) or Annual Notice of Change (ANOC). These notices detail any changes to the upcoming plan year, regarding costs or coverage limits. It is important to review these notices when they arrive, so that you don’t receive any unpleasant surprises during the next plan year. Never just assume that your current plan will remain the same.

If it looks like your plan might be changing, contact us right away to determine your next action. We can help you compare different plans and select one that fits your needs.

Even if your plan is remaining relatively the same, your needs could be changing. Speak with your primary care physician about your personal risks, medications that you might need in the near future, upcoming treatments, and more. If it looks like you might face increased or different healthcare needs in the near future, you should also reevaluate your Medicare plan to be sure it’s a good fit for you.

  • During the Annual Election Period, you can take the following actions:
  • Switch from one Medicare Advantage plan to another
  • Drop Medicare Advantage and go back to Original Medicare
  • Switch from Original Medicare into an Advantage plan
  • Add, change, or drop Prescription (Part D) coverage

Any changes you make to your plan(s) will take effect on January 1, 2021. Again, the deadline to make these changes is rapidly approaching on December 7. If you haven’t already contacted us to discuss your options, now is the time to do so.

Take Advantage of the Small Group Special Enrollment Period Now

Many small business owners wish they could provide group health benefits to their workers, but several obstacles stand in their way. First, premiums can seem unmanageable to smaller businesses. Second, the required participation rate of 70 percent of employees might be unattainable for numerous reasons. Still, small business owners don’t deny the potential benefits of a group health plan to both themselves and employers.

If that sounds familiar, we have good news: The Small Group Special Enrollment Period was designed to allow employees of small businesses to enroll in a group health plan, while sidestepping the rules that would normally prevent their participation.

Under the Small Group Special Enrollment rules, employers are not subject to participation minimums. This means as long as one – yes, just one – employee signs up, they can enjoy a group health plan.

As for the cost of premiums, business owners are not subject to any requirement to contribute. They can pay for part, all, or none of the plan as their budget allows, passing on any difference to employees who choose to participate. Workers are happy because they can access a plan of their liking, and business owners are happy with the flexibility of their contributions. Everyone wins!

In addition, if the employer establishes a cafeteria plan, employees can access valuable tax savings. By paying for premiums through pre-tax payroll deductions, they can earn a significant deduction on their income tax obligation.

Finally, the healthcare plans offered under Small Group Special Enrollment are subject to the same underwriting guidelines required by law. Employees can access quality healthcare plans even though their employers won’t be subject to strict regulation of their contribution.

There’s just one drawback of this special enrollment period: It only lasts for one month, between November 15 and December 15 (with coverage beginning January 1). Give us a call now to begin weighing your options, so that employees have time to make a decision about group health plans.

Covered California Update: Open Enrollment Begins Soon!

For those of you who are enrolled in a Covered California healthcare plan, Open Enrollment will soon begin. During this time, you will be able to enroll in a new plan or make changes to your current plan. With 2020 bringing so many changes to our lifestyles and budgets, we should all pay close attention to Open Enrollment this year.

Here’s what you need to know:

Open Enrollment begins November 1 and runs through January 31, 2021. However, if you want your new plan to begin on January 1, you need to complete your application by December 15.

Even though you have until January 31 to enroll, we do recommend getting started early. Your healthcare plan is a big decision, and one that can bring many financial consequences. Begin to evaluate your current spending now and anticipate next year’s healthcare needs. Did you meet this year’s deductible? Would you prefer lower premiums? Ask yourself these questions now, to begin narrowing your focus.

If your financial information has changed, be sure to update it in the system. Your subsidy, if you receive one, is based upon your financial information. Submitting accurate data is the best way to ensure that you receive the correct subsidy. If your income has dropped this year, you might qualify for help even if you have not qualified in the past.

Outside of Open Enrollment, there are other times you can make changes to your plan. If you have a baby, adopt a child, move, experience a change of employment, or experience certain other qualifying life events, you can make changes to your Covered California plan within 60 days.

Medi-Cal enrollment is year-round. If you have experienced a qualifying life event, and you believe you might now be eligible for Medi-Cal, you do not have to wait on Open Enrollment. You can apply now.

You can receive help with your application. If you need help evaluating plans, submitting your application, or anything else regarding Covered California Open Enrollment, contact us right away. We can help get the ball rolling. Remember, Open Enrollment begins November 1 but you should start getting ready as soon as possible.


Medicare Annual Election Period Starts Today: Here’s What to Do Now

How are you liking your Medicare plan? Do you ever wonder if you could achieve better coverage or lower out-of-pocket costs with a different plan? Would you like to compare plans, and try to identify a better fit for your healthcare needs?

That’s the point behind the Annual Election Period, which runs from October 15 to December 7 each year. During this time, beneficiaries can make changes to Medicare Advantage plans and Part D plans. Now is the time to compare coverage, premiums, and potential out-of-pocket costs among different plans. If you decide that another plan is a better fit for you, you can change your enrollment during this time period.

Plans can and do change each year. Each year, Medicare plan administrators can make certain changes to their costs, benefits, coverage, or the network of providers and participating pharmacies. By this point, you should have received either an Evidence of Change (EOC) notice and/or an Annual Notice of Change (ANOC) from your plan administrator. If you haven’t already, now is the time to review these materials and determine whether the plan’s coverage and cost still meets your needs. If it doesn’t, or if you’re not sure, we can help you review these materials and make a decision about your healthcare plan.

Comparison shopping is always wise. In some cases, your plan might not be changing much, but you still wonder if another plan would be a better fit. Comparison shopping might save you money or help you identify a better deal. Give us a call and we can help with that too.

Here’s what you’re able to do during the Annual Election Period:

  • Change from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan back to Original Medicare
  • Change from one Medicare Advantage plan to another
  • Enroll in a supplemental Part D plan (for prescription drugs)
  • Change from your current Part D plan to a different one
  • Drop Part D coverage altogether

If you decide to make a change, your new plan will take effect on January 1, 2021.

Healthcare is one of the most important decisions you will make each year. Let’s discuss your current plan, and then compare it to other options. Together we can make sure you’re enrolled in the best plan for you.

Attention Employers: Send Notices of Creditable Coverage by October 15

As Medicare’s Annual Election Period rapidly approaches, employers should take note: Notices of Creditable Coverage must be sent by October 15. These notices must be sent to all employees over age 65, and any other employee or their dependent who is eligible for Medicare.

Creditable coverage means that a healthcare plan is expected to pay, on average, as much as the standard Medicare Part D plan toward a beneficiary’s prescription medications. The plan is equivalent in coverage to what a Part D plan would offer.

A notice of creditable coverage tells the covered individual that the prescription drug policy offered by their healthcare plan qualifies as “creditable coverage”.

These notices must be sent prior to October 15 each year, allowing the covered individual time to make decisions regarding his or her Medicare enrollment before the Annual Election Period. Employers must send a notice of creditable coverage to all Medicare-eligible employees, COBRA-covered individuals, and retirees covered by their group healthcare plan. Additionally, all dependents of these individuals must also receive a notice.

Why does this matter to the employee? Under the Medicare Modernization Act, individuals who do not maintain prescription drug coverage for 63 days or longer, following their initial date of Medicare eligibility, will be charged a late enrollment penalty.

However, if the individual has creditable coverage through a group healthcare plan, they are not required to enroll in Part D or face the late enrollment penalty.

But if the individual’s coverage is not creditable, they should evaluate whether enrolling in Medicare Part D would be a wise choice for them.

So, the notice of creditable coverage gives these individuals the information they need to make responsible decisions regarding their Medicare prescription drug coverage.

Notices must be filed with Medicare as well. In addition to the individual notices, employers must file an online disclosure with Medicare, certifying creditable coverage of their group healthcare plan. This disclosure must be filed

  • Within 60 days of the beginning of the plan’s contract year
  • Within 30 days of termination of a prescription drug plan
  • And within 30 days of changes to the status of creditable coverage

For more information on notices of creditable coverage, contact us and we can answer your questions. We can help you evaluate your situation and ensure that your company complies with the law while protecting your employees.

Understanding the ABCs of Medicare

When you first become eligible for Medicare, it can be easy to feel overwhelmed with all of your options. This brief guide should help you to understand the different parts of Medicare, so that you can make the selections that are right for your needs.

Medicare Part A and Part B comprise Original Medicare, and work together to form the base of your healthcare needs, so we’ll start by explaining those.

Assuming you’ve worked and paid taxes into the Medicare system for at least 40 quarters in your life, you can enroll in Medicare Part A at age 65 without owing a premium. This will serve as your hospitalization insurance, and will cover costs related to inpatient care in a hospital or skilled nursing facility (subject to some limits). Part A also covers Hospice care or home health care.

Medicare Part B provides for non-hospitalization healthcare needs, such as

  • Doctor visits, tests, and other services to diagnose or treat health conditions
  • Preventive services (routine screenings, check-ups, vaccinations, etc)
  • Mental health services
  • Clinical research
  • Ambulance services
  • Medical equipment
  • Some outpatient prescription drugs (limited)

Medicare Part C Plans – also called Medicare Advantage plans – are private health insurance plans designed to offer coverage that is equivalent to Original Medicare. By contracting with Medicare, private insurance companies offer comprehensive health insurance plans through a variety of formats:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs Plans (SNPs)
  • HMO Point of Service Plans (HMOPOS)
  • Medicare Medical Savings Account (MMSA)

Many Advantage plans also include Part D, or prescription drug coverage. If you choose Original Medicare instead, you can also enroll in Part D to help manage your medication costs.

Now that you’re familiar with the basics, give us a call if you need help making decisions about your Medicare coverage. We can help you understand the benefits and limits of each type of plan, and select the one that is right for your needs and budget.

What to Do If You’ve Lost Your Health Insurance

As the economy continues to struggle toward recovery, job losses due to layoffs and company closings continue to occur. Unfortunately, for some of you that will mean loss of health insurance benefits as well. If you’re wondering what to do, we’ve outlined your options below.

Continue on your current health insurance plan through COBRA. When employees are laid off, federal law requires the employer to allow those employees to continue their group health insurance plans if they choose to do so. However, under the COBRA law you would be tasked with paying the full cost of premiums, including the share your employer formerly covered.

This might be a feasible option for those whose spouses are still employed, and can cover the full cost of premiums. But for many people facing unemployment, continuing COBRA coverage is not a financial possibility.

Enroll in an individual health insurance plan via a Special Enrollment Period. If continuing your group healthcare benefits is not an option, do remember that job loss qualifies you for a Special Enrollment Period through Covered California. You can compare plans and enroll in one that fits your needs and budget. You might also be eligible for a subsidy to help with the cost of premiums, especially if your income is now limited.

Depending upon income, you might be eligible for Medi-Cal at no cost.

If you’re facing this unfortunate situation, do remember that you have options, and you don’t have to go without health insurance. Give us a call to discuss those options, and we can walk you through the different choices that might fit your healthcare needs and budget. In the meantime, we’ll keep you updated with any new provisions supplied by the federal or state government as they continue to adopt measures to help those whose employment has been impacted at this time.

Your Medicare Annual Election Period Opens Soon

Each year, Medicare operates their Annual Election period from October 15 through December 7. During this time, you can make changes to your Medicare plan for the following year. Even those of you who have been satisfied with your plans in the past should do four things:

1.Review your out-of-pocket spending for the past year. Is it in line with your budget? Are you satisfied with your expenses or would you prefer to reduce them?

2. Discuss upcoming healthcare needs with your physician. Do you anticipate needing specific procedures in the next year? Are you satisfied with your prescription medications, or would you prefer to try something new? Are you at risk for any conditions for which you should be screened, or might need treatment in the near future? Will your current Medicare plan continue to meet those needs?

3. Read all notices mailed to you from Medicare or your Advantage Plan provider. Even if you have been satisfied with your plan in the past, you can’t assume that it will stay the same forever. Plan administrators can and do make changes from one year to the next, but you might not learn about them unless you read these notices.

4. Discuss your budget, out-of-pocket spending, changes to your plan, and any other concerns with an experienced Medicare agent.

Give us a call, and we can help you determine whether your current plan is still suited for your present and future needs. We will evaluate your spending, compare plans, and investigate whether a different plan might be a better fit for you. We can also discuss various supplemental coverage at this time, depending upon your interest.

Most importantly, remember that plans do change. What worked for you last year might not continue to work in the future.

We will be holding a free virtual workshop on September 2, to help you investigate these issues and answer your questions. If you would like to attend, click this link to sign up. We can help you take the above steps so that you’re ready when the Annual Election Period opens on October 15.

Research Your Medicare Options Before You Move

When you’re planning a move out of state, health insurance issues might not fall at the top of your to-do list. Many people assume that their Medicare insurance plan will transfer to their new state, or that a similar option will be readily available after the move. But due to differences in some Medicare plan offerings, these assumptions are not necessarily true. Here’s what you need to know about Medicare when you’re planning a move.

Moving qualifies you for a Special Enrollment Period. Moving is one of the special circumstances under which you are granted a Special Enrollment Period to change your plan(s).

Those enrolled in Original Medicare Parts A and B probably don’t need to make changes. Original Medicare is not based upon provider networks, so you can use your insurance anywhere that accepts Medicare. So if you’re enrolled in Original Medicare Parts A and B, you can always access medical care anywhere in the United States.

Those enrolled in Medicare Part C (Advantage) or Part D (prescription plans) should research their options. Part C and D plans are based upon provider networks, which can differ from one area to another. Your plan offerings might not be commensurate between states.

You might also prefer to research providers and facilities in your new area of residence, so that you gain an understanding of your care preferences. Then, speak to an insurance professional in that state to learn about your Medicare options. In some cases your current plan(s), or something very similar, might be available in the new state.

If the Advantage plans in your new area do not meet your needs, you can also return to Original Medicare.

Those with Medigap plans might require a change. Sometimes those who are enrolled in Original Medicare plus Medigap can keep their old plans and use them anywhere. However, a type of Medigap policy, called Medicare SELECT plans, are based on provider networks. That plan might include a guaranteed-issue right to enroll in a new plan when you move out of the provider network area.

Talk to your Medicare plan administrator before you move. When notifying a plan administrator prior to a move, the Special Enrollment Period begins the month before the month of the scheduled move, and continues for two months afterward. When you wait until after the move to notify your plan administrator, the Special Enrollment Period begins that month and continues for two months afterward.

Plan ahead to gain more time to weigh your options, and you can transition more smoothly into your new life. When selecting options such as Medicare Part C or Medigap plans, you will also be able to evaluate premium expenses to accommodate your changing budget.


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