On Medicare Advantage? California Residents With Health Issues May Have a Way to Switch to a Medicare Supplement

If you or someone you know has a Medicare Advantage (MA) plan and has developed health issues, there may be an important opportunity to explore this fall. Every fall, MA plans send their members an important document called an Annual Notice of Change (ANOC). This document explains how the plan’s premiums, costs, benefits, and other coverage details will change for the following year.

For many people, the ANOC is something they receive in the mail and put away without giving it much thought. But if you or someone you know has an MA plan and has been thinking about returning to Original Medicare (Part A and Part B), it is worth taking a closer look.

Thinking About Leaving Medicare Advantage?

Some people who have been enrolled in MA plans eventually decide they would prefer Original Medicare along with a Medicare Supplement, also known as a Medigap policy.

One reason people hesitate to make that change is medical underwriting. Outside of certain guaranteed issue situations, someone applying for a Medicare Supplement may have to answer health questions and could be declined because of their health history. In some circumstances, a Medicare Supplement policy may also cost more when medical underwriting applies. That can be especially concerning for someone who developed significant health problems after enrolling in Medicare Advantage. However, California has specific protections for certain MA members whose plans make significant changes.

What Is an Annual Notice of Change?

MA plans generally send their ANOCs in September. The document explains changes that will take effect the following year, including changes to premiums, cost sharing, benefits, and other aspects of the plan.

For 2027 (and every year) the Medicare Annual Election Period (AEP) runs from October 15th through December 7th. During this period, Medicare beneficiaries can make certain changes to their Medicare coverage, including returning to Original Medicare.

During the AEP, Medicare beneficiaries can also review and change their Medicare Part D prescription drug coverage for the following year. If you are returning to Original Medicare from a Medicare Advantage plan, it is especially important to make sure you have appropriate prescription drug coverage in place, since Original Medicare generally does not include Part D prescription drug coverage.

A California Protection You Should Know About

California Insurance Code Section 10192.12 provides guaranteed issue protections in certain situations for people enrolled in MA plans. For example, if an MA plan does any of the following:

  • Increases its premium by 15% or more
  • Increases physician, hospital, or drug copayments by 15% or more
  • Reduces benefits
  • Or discontinues its relationship with a provider who is currently treating the individual, other than for certain quality of care reasons

The individual may qualify for a Medicare Supplement without being medically underwritten, subject to the requirements of California law. This can be especially important for someone who has developed health conditions since enrolling in Medicare Advantage and might otherwise have difficulty qualifying for a Medicare Supplement.

It is important to understand that not every cost increase qualifies. The California law specifically refers to a 15% or greater increase in the MA plan’s premium or in physician, hospital, or drug copayments. Simply seeing a 15% increase in any cost listed in your ANOC does not necessarily mean you qualify for guaranteed issue. That is why it is important to review the actual changes carefully and determine whether the specific circumstances meet the requirements.

Which Medicare Supplement Company Can You Choose?

There is another important detail to understand about California’s guaranteed issue protections. If your MA plan makes a qualifying change, California law generally gives you the right to obtain a Medicare Supplement from the same insurance company that provides your MA plan, if that company offers Medicare Supplement policies. The law also provides for certain related companies, including a subsidiary of the parent company or a network that contracts with the parent company.

If a Medicare Supplement is not available through those related companies, you may be eligible to obtain a Medicare Supplement from another insurance company if your MA plan has made one of the qualifying changes described above, such as increasing the premium by 15% or more, increasing physician, hospital, or drug copayments by 15% or more, or reducing benefits.

For an unaffiliated Medicare Supplement company, the enrollment normally takes place during the AEP. That is one reason it is important to review your ANOC early and understand exactly what your options may be.

Don’t Just File Away Your Annual Notice of Change

When your ANOC arrives, don’t simply put it in a drawer. Take a few minutes to compare your current year’s costs and benefits with what your plan will offer in the coming year.

Pay particular attention to the following:

Premium Changes

  • Will your monthly premium increase by 15% or more?

Copayments

  • Are your physician, hospital, or prescription drug copayments increasing by 15% or more?

Benefits

  • Are any benefits being reduced or eliminated?

Your Providers

  • Will your doctors, hospitals, or other providers continue to participate in your plan?

If you notice significant changes, don’t assume that you have to remain in your MA plan simply because you have developed health problems. You may have options worth exploring.

Need Help Reviewing Your ANOC?

If you have an MA plan and receive your Annual Notice of Change, you are welcome to send me a copy of your ANOC. I can review the changes with you and help determine whether they may qualify you for guaranteed issue rights to a Medicare Supplement under California law.

If you are considering returning to Original Medicare, I can also help you understand your Medicare Supplement options. If you would like me to review your ANOC, simply email it to me at Ron@RonLewisInsurance.com. I’m happy to help you understand your options.

Why This Can Be Especially Important If Your Health Has Changed

Imagine someone who enrolled in an MA plan several years ago when they were relatively healthy. Since then, they may have developed heart disease, cancer, kidney disease, diabetes, or another significant medical condition. Today, they would like to return to Original Medicare and purchase a Medicare Supplement, but they are concerned that their health history could make it difficult to qualify. That is exactly why California’s protections can be important.

A qualifying change to the MA plan may create a guaranteed issue opportunity that could otherwise be unavailable. However, eligibility is based on the specific circumstances, the plan changes, the timing of the disenrollment and the applicable Medicare Supplement rules. A qualifying change does not automatically mean that every Medicare Supplement plan from every carrier is available.

Don’t Wait Until December 7th

If you are considering a change, don’t wait until the last minute. The Medicare Annual Election Period (AEP) runs from October 15th through December 7th each year. If you believe your ANOC shows a change that may give you guaranteed issue rights under California law, it is a good idea to have your situation reviewed early in the AEP.

That gives you time to review your current Medicare Advantage coverage, examine the changes in your ANOC, determine whether you may qualify for guaranteed issue, compare available Medicare Supplement options, complete an application if appropriate, and allow time for the application and enrollment process.

Know Your Options

If you or someone you know has Medicare Advantage and has developed significant health problems, don’t automatically assume that returning to Original Medicare and obtaining a Medicare Supplement is impossible. The ANOC may reveal changes that are important to your Medicare options for the coming year.

And this information isn’t just for you. If you have a parent, spouse, friend, relative, or someone else you care about who has Medicare Advantage, particularly someone with significant health issues, consider forwarding this article to them. Encourage them to review their ANOC when it arrives. A few minutes spent reviewing that document could be very important.

If you see a qualifying increase in premiums or specified copayments, a reduction in benefits, or another situation described under California law, reach out to me or another licensed Medicare insurance professional to find out whether you may qualify for guaranteed issue Medicare Supplement coverage.

I’m always happy to help you understand your options and determine whether these protections may apply to your situation.

This article is for educational purposes only and is not intended to provide legal, tax, or insurance advice. Medicare and California Medicare Supplement rules are subject to change. Guaranteed issue rights depend on the individual’s specific circumstances, the Medicare Advantage plan’s changes, timing, and applicable federal and California rules. Eligibility for a particular Medicare Supplement policy is not guaranteed by this article.

About the Author

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis
Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonlewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

  • California: #0B33674
  • Nevada: #3822123
  • Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.

The Cholesterol Test You May Not Have Had: Why Lp(a) Matters

When was the last time you had your cholesterol checked? If you are like most people, you have probably had a standard cholesterol panel many times. But there is another cholesterol-related blood test that you may never have had checked, and you may want to ask your doctor about it. It is called lipoprotein(a), or Lp(a).

Lp(a) blood test shown with a heart and cholesterol panel, illustrating why Lp(a) testing may be important for heart health.

What Is Lp(a)?

Lp(a) is a type of lipoprotein in your blood that is largely determined by your genetics. Unlike your regular cholesterol numbers, your Lp(a) level is generally established early in life and remains relatively stable throughout your lifetime. A high Lp(a) level is associated with an increased risk of cardiovascular disease, including heart attack and stroke.

One important thing to know is that Lp(a) is not included in a standard cholesterol panel. Your routine blood work may include total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. Lp(a), however, requires a separate blood test.

A New Recommendation for 2026

There is an important reason to pay attention to Lp(a) now. The 2026 American College of Cardiology and American Heart Association cholesterol guidelines recommend that Lp(a) be measured at least once in every adult’s lifetime.

Because Lp(a) is largely determined by genetics and tends to remain relatively stable, most people do not need to have it checked repeatedly. If you have never had your Lp(a) measured, consider asking your doctor whether the test would be appropriate for you.

Want to learn more? The American Heart Association provides information about the 2026 Guideline on the Management of Dyslipidemia, including its recommendation regarding Lp(a). Please click here for more details.

Why Does Lp(a) Matter?

Having a high Lp(a) level does not mean that you are destined to have a heart attack or stroke. Instead, it gives your doctor another piece of information to consider when evaluating your overall cardiovascular risk. Your doctor can look at your Lp(a) level along with other factors such as your LDL cholesterol, blood pressure, diabetes status, family history and other health information. This can help provide a more complete picture of your cardiovascular health.

“But My Cholesterol Is Normal”

This is one reason Lp(a) is so interesting. Someone can have a relatively good LDL cholesterol number and still have an elevated Lp(a) level. That is because Lp(a) provides different information than the cholesterol numbers found on a standard lipid panel. Knowing your Lp(a) level may give your doctor additional information when determining your overall cardiovascular risk.

What Can You Do About a High Lp(a)?

Because Lp(a) is largely determined by genetics, diet and exercise do not substantially lower the Lp(a) number itself. That does not mean a healthy lifestyle is unimportant. Eating a heart healthy diet, exercising regularly, maintaining a healthy weight, avoiding tobacco and managing blood pressure and LDL cholesterol are all important ways to reduce your overall cardiovascular risk. If your Lp(a) is elevated, your doctor may pay particular attention to controlling other cardiovascular risk factors, particularly LDL cholesterol.

What About Medicare Coverage?

This is an important question for Medicare beneficiaries. Medicare coverage for Lp(a) testing can depend on the reason the test is ordered and whether Medicare considers it medically necessary under the applicable coverage rules. It is important not to assume that Medicare will automatically cover the test simply because a doctor orders it.

If your doctor recommends an Lp(a) test, ask the doctor’s office or laboratory whether Medicare is expected to cover it and whether you could have an out of pocket expense. If Medicare does not cover the test, the good news is that Lp(a) testing can be relatively inexpensive when paid for directly.

For example, Quest currently lists its Lp(a) test at $45, plus a $6 physician service fee, while Labcorp currently lists its Lp(a) test for $49. Prices can change, and other laboratories may charge different amounts. For a test that most people may only need once in their lifetime, that may be a relatively affordable way to learn an additional piece of information about your cardiovascular risk.

One Simple Question to Ask Your Doctor

If you have never had your Lp(a) checked, consider asking: “Have I ever had an Lp(a) blood test? If not, would it make sense for me to have one?” You may already know your cholesterol numbers, but you may not know your Lp(a). With the new 2026 cholesterol guidelines recommending that every adult have Lp(a) measured at least once, it is worth having a conversation with your doctor.

The bottom line: Knowing your cholesterol is important, but Lp(a) may provide another piece of the puzzle when it comes to understanding your heart health.

This article is for educational purposes only and is not intended to provide medical advice. Talk with your physician about whether Lp(a) testing is appropriate for you and about your individual cardiovascular risk and potential insurance coverage.

About the Author

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis
Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonlewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

  • California: #0B33674
  • Nevada: #3822123
  • Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.

Why Did My Medicare Supplement Premium Go Up If I Never Used My Insurance?

Medicare Supplement rate increases illustrated with an upward arrow, rising bars, and a dollar sign.
Medicare Supplement premiums can increase over time for a variety of reasons, including age, healthcare costs, and insurance company pricing.

You may have asked yourself this question: “I barely used my Medicare Supplement plan this year, so why did my premium go up?”

It is a common question and an understandable one. Unlike some types of insurance where your individual claims history can directly affect what you pay, Medicare Supplement insurance premiums are not simply based on how much you personally used your coverage. Your premium can change even if you rarely visit the doctor, have never been hospitalized, or have not filed a single claim.

For Medicare beneficiaries in California, several factors can influence the premium you pay, including your age, ZIP code, insurance company, and whether you qualify for certain household discounts. Medicare.gov also notes that Medigap premiums typically increase over time and can vary among insurance companies.

Your Premium Is Not Based on How Much You Personally Use Your Insurance

One of the biggest misconceptions about Medicare Supplement insurance is that your premium should stay the same if you do not use your policy. That is not how Medicare Supplement pricing works.

A Medicare Supplement policy is designed to help cover certain costs associated with Original Medicare (Part A and Part B). The insurance company collects premiums from policyholders and uses those premiums to help pay covered claims across its pool of insured individuals. That means your premium is not calculated simply by adding up the medical services you personally used during the year. So if you had a healthy year and barely used your Medicare Supplement policy, you could still receive a premium increase. And that is normal.

Why Can Medicare Supplement Premiums Increase?

Why Medicare Supplement premiums can increase due to age, location, insurance company, household discounts, and healthcare costs.
Medigap premiums can increase over time for several reasons, even if you rarely use your insurance.

There is not necessarily one single reason for a rate increase. Various factors can cause this.

1. Your Age

Age can be an important factor in determining Medicare Supplement premiums. As you get older, your premium may increase depending on how your policy is priced. Premiums can also increase for reasons unrelated to your individual healthcare usage. This is one reason it is important to understand not only what you are paying today, but also how your premium may change over time.

2. Where You Live

Your location can also affect the price of Medicare Supplement insurance. In California, Medicare Supplement rates can vary based on factors such as age and ZIP code. This means that two people with the same Medicare Supplement plan may not necessarily pay the same premium if they live in different areas. If you move to a different ZIP code, your available rates may change as well.

3. The Insurance Company

Here is something many Medicare beneficiaries do not realize. Two insurance companies can offer the same Medicare Supplement plan and charge different premiums.

Medicare Supplement plans are standardized. For example, the basic benefits of Plan G are the same regardless of which insurance company sells the Plan G policy. However, the premium can be very different from one insurance company to another. So if your Plan G premium increased, that does not necessarily mean that Plan G itself changed. It may simply mean that another insurance company is currently offering the same standardized benefits at a lower premium.

The benefits are standardized. The premiums are not. This is one reason why reviewing your Medicare Supplement premium periodically can be worthwhile.

4. Household Discounts

Some insurance companies offer household discounts to qualifying individuals. Depending on the insurance company, a discount may be available when you live with a spouse, domestic partner, roommate, or another qualifying household member. These discounts can make a meaningful difference in the amount you pay each month. However, not every insurance company offers the same discount, and eligibility requirements can vary. This is another factor that can affect the premium you pay.

5. Overall Healthcare and Insurance Costs

Even if you personally have not used your Medicare Supplement policy very much, the insurance company is still paying claims for the larger group of people it insures. Changes in healthcare costs, medical services, utilization, and other factors can affect an insurance company’s overall expenses. As those costs change, premiums can change as well.

The Same Plan Does Not Always Mean the Same Price

This is one of the most important things to understand about Medicare Supplement insurance. Let assume that you have a Plan G policy. Your Plan G benefits are standardized. However, several insurance companies may offer Plan G in your area, and their premiums will be very different. For example, one insurance company might offer a Plan G for $180 per month while another might charge $215 or $240 for the same standardized plan.

That does not automatically mean the more expensive company provides better Plan G benefits. The benefits are standardized, but the premiums are not. This is why comparing Medicare Supplement rates can be valuable.

Should You Change Your Medicare Supplement Plan Because Your Premium Increased?

Not necessarily. A premium increase does not automatically mean you should switch insurance companies. There are several things to consider before making a change, including your current premium, the rates available from other companies, your eligibility for a new policy, and whether switching makes sense for your individual situation.

It is also important to understand that switching Medicare Supplement policies is not always as simple as switching other types of insurance. Outside certain protected situations, an insurance company may be able to use medical underwriting when you apply for a new Medicare Supplement policy. That is why you should never cancel your existing Medicare Supplement policy simply because you found a lower advertised rate. Always make sure your new coverage is approved and in place before cancelling your existing policy.

Why an Annual Medicare Supplement Review Can Make Sense

Your Medicare Supplement premium can and usually will change from year to year. This is why I believe it makes sense for Medicare Supplement policyholders to periodically review their coverage and current premium.

For my California clients, I review their Medicare Supplement options around their birthday each year. I look at factors such as their current premium, age, ZIP code, available plans, household discount eligibility, and rates from other insurance companies.

Many times I find an opportunity for my clients to save money, and sometimes the best decision is to stay exactly where they are. The goal is not to change your plan every year. The goal is to make sure you understand your options and are not paying more than necessary for comparable coverage.

California’s Birthday Rule Can Be Especially Important

California Medicare beneficiaries have an additional opportunity that can make an annual review particularly valuable.

Under the California Medicare Supplement Birthday Rule, eligible individuals who already have Medicare Supplement coverage have a 60 day window following their birthday each year to switch to another Medicare Supplement policy with the same or fewer benefits without medical underwriting.

For example, if someone has a Plan G Medicare Supplement, they can switch to Plan G with any other insurance carrier, regardless of their health. Or, they could switch to Plan N, etc. because Plan N has fewer benefits than Plan G. Under the birthday rule, you cannot switch from Plan N to Plan G because Plan G has greater benefits than Plan N, etc.

This can make your birthday more than just a day to celebrate. It’s a good time to review your Medicare Supplement coverage. For California policyholders, this annual review can be especially important because rates usually increase from year to year.

The Bottom Line

If your Medicare Supplement premium increased even though you barely used your insurance, you didn’t do anything wrong. Premiums can change for a variety of reasons, including age, location, insurance company pricing, household discounts, and broader healthcare costs.

It’s normal for rates to increase every year as we get older, and that’s why it’s important to review your coverage every year around your birthday and to take advantage of the California Birthday Rule. You do not have to change plans just because your premium went up. But you should know what your options are.

A Medicare Supplement review is not about changing your plan every year. It is about making sure the coverage you have continues to make sense for you and that you are aware of your available options.

Final Thoughts

Medicare is an excellent health insurance program, but it was never designed to cover every healthcare expense. Understanding these coverage gaps can help you avoid unexpected costs and build a more complete healthcare strategy.

If you have questions about Medicare Supplement plans or would like to review your coverage options, feel free to contact me. I am always happy to help you understand your choices and find competitively priced coverage that meets your needs.

About the Author

Ron Lewis, Independent Medicare Supplement Insurance Specialist, offering free Medicare consultations.

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis

Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonlewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

  • California: #0B33674
  • Nevada: #3822123
  • Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.

What Medicare Does NOT Cover: Understanding the Gaps in Your Coverage

Illustration of a puzzle with a missing piece representing what Medicare does not cover, including common coverage gaps.

Many people approaching age 65 are surprised to learn that Medicare does not cover every healthcare expense. While Medicare provides valuable health insurance protection, there are important gaps that can leave beneficiaries responsible for significant out-of-pocket costs.

Understanding what Medicare does not cover can help you make informed decisions about Medicare Supplement insurance and other types of coverage.

Long-Term Care

Illustration showing that Medicare generally does not cover long-term custodial care.

One of the biggest misconceptions about Medicare is that it covers long-term care.

Medicare may pay for a limited stay in a skilled nursing facility following a qualifying hospital stay, but it generally does not cover custodial care. Custodial care includes assistance with activities of daily living such as bathing, dressing, eating, and personal care when that is the primary need. The cost of long-term care can be substantial, making it important to plan ahead.

Routine Dental Care

Illustration showing that Medicare generally does not cover routine dental, vision, or hearing care.

Original Medicare generally does not cover routine dental services such as:

  • Regular cleanings
  • Dental exams
  • Fillings
  • Crowns
  • Dentures
  • Most tooth extractions

Because dental expenses can add up quickly, many beneficiaries choose to purchase separate, stand-alone, dental insurance. Many dentists offer their own dental plans, so you should also check with your dentist.

Routine Vision Care

Medicare does not typically cover routine eye exams for glasses or contact lenses.

Most beneficiaries are responsible for:

  • Eye exams for prescription glasses
  • Eyeglasses
  • Contact lenses
  • Lens upgrades

Medicare may cover certain medically necessary eye treatments and surgeries, but routine vision care is generally excluded.

Hearing Aids

Hearing loss is common among older adults, yet Medicare generally does not cover the following:

  • Hearing aids
  • Hearing aid fittings
  • Routine hearing exams for hearing aid purposes

Since hearing aids can cost thousands of dollars, many beneficiaries seek separate coverage or discount programs.

Medical Care Outside the United States

Illustration showing Medicare's limited foreign travel coverage and the need for prescription drug coverage through Medicare Part D.

Many people are surprised to learn that Medicare provides very limited coverage outside the United States.

Some Medicare Supplement plans include a foreign travel emergency benefit, but coverage is limited and subject to certain conditions. If you plan to travel internationally, purchasing a travel medical insurance policy is a wise decision.

Prescription Drug Costs

Original Medicare does not provide comprehensive prescription drug coverage.

Beneficiaries who want prescription drug coverage typically enroll in a Medicare Part D prescription drug plan (PDP) or choose a Medicare Advantage plan that includes drug coverage. Without prescription coverage, medication costs can become very expensive.

It’s also important to understand that Medicare beneficiaries who do not enroll in a Medicare PDP when they are first eligible for Medicare may face a late enrollment penalty if they decide to enroll later. This penalty is generally added to their Part D premium and can continue for as long as they have prescription drug coverage.

Even individuals who currently take few or no medications may want to consider enrolling in a low-cost Part D plan when first eligible in order to protect themselves from future penalties and ensure they have coverage in place if their prescription needs change. Some PDPs have a $0 monthly premium, but the best PDP depends on what medications someone takes.

California Health Insurance Counseling and Advocacy Program

In California (and other states) there is a volunteer organization called California Health Insurance Counseling and Advocacy Program (HICAP). They provide FREE prescription drug plan counseling. You can call them and set up an appointment to see someone at a local office or they may be able to answer your questions over the phone.

Here is their contact information:

California Health Insurance Counseling & Advocacy Program (HICAP)
https://www.shiphelp.org/ships/california/
800-434-0222

Most Cosmetic Procedures

Medicare generally does not cover procedures performed solely for cosmetic reasons, including elective surgeries intended to improve appearance rather than treat a medical condition.

Why Most People Choose Medicare Supplement Insurance

While Medicare Supplement insurance does not cover dental, vision, hearing aids, or long-term care, it can help pay many of the out-of-pocket costs left behind by Original Medicare (Parts A and B) such as deductibles, copayments, and coinsurance.

Original Medicare provides valuable coverage, but it does not cover all healthcare expenses. For many covered Part B services, beneficiaries are responsible for 20% of the Medicare-approved amount after meeting the Part B deductible. In addition, Original Medicare does not have a yearly out-of-pocket maximum for these costs, which can make healthcare expenses difficult to predict.

A Medicare Supplement plan helps reduce some of these out-of-pocket expenses and provides greater financial predictability. This added protection offers greater confidence when planning for future healthcare costs.

As an independent insurance agent, I help clients compare Medicare Supplement options from multiple insurance companies. Since Medicare Supplement plans with the same letter designation offer the same standardized benefits, comparing carriers can help identify differences in premiums, pricing stability, and customer service.

Final Thoughts

Medicare is an excellent health insurance program, but it was never designed to cover every healthcare expense. Understanding these coverage gaps can help you avoid unexpected costs and build a more complete healthcare strategy.

If you have questions about Medicare Supplement plans or would like to review your coverage options, feel free to contact me. I am always happy to help you understand your choices and find coverage that meets your needs.

About the Author

Ron Lewis, Independent Medicare Supplement Insurance Specialist, offering free Medicare consultations.
Ron Lewis is an Independent Medicare Supplement Insurance specialist helping Medicare beneficiaries review their coverage and options.

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis
Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonLewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

  • California: #0B33674
  • Nevada: #3822123
  • Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.

Medicare Fraud Warning Signs in 2026: What Every Beneficiary Should Know

Medicare card security update showing protection against fraud and new Medicare card number replacement notice for 2026
Some Medicare beneficiaries are receiving new Medicare card numbers as part of ongoing fraud protection efforts

Recently, some Medicare beneficiaries have heard that new Medicare card numbers are being issued in 2026. Many people are wondering whether this affects them. Here is what you should know.

Are Medicare Card Numbers Changing This Year

Yes, but only for a small number of people. The Centers for Medicare & Medicaid Services is mailing new Medicare card numbers to certain beneficiaries as part of a security update related to fraud prevention. If you are affected, your new card will arrive automatically by mail. You do not need to request one.

NOTE: Most Medicare beneficiaries will not receive a new number.

Why Some Medicare Numbers Are Being Replaced

From time to time, the Centers for Medicare and Medicaid Services updates Medicare identification numbers for certain beneficiaries as part of ongoing efforts to protect personal information and reduce fraud. If your number is affected, Medicare automatically sends a replacement card by mail and no action is required from you.

What Should You Do If You Receive a New Medicare Card

If you receive a new Medicare card in the mail, you should do the following:

  • Start using the new number immediately
  • Safely destroy your old card
  • Share your new number with your doctors if needed
  • Let your insurance agent know so your records stay updated

There is no cost for a replacement Medicare card. If your Medicare card is lost or damaged, you can request a replacement card at any time through your secure account at Medicare.gov or by calling (800) MEDICARE. Replacement cards are mailed directly from Medicare and there is never a fee for this service.

Important Fraud Warning

Medicare fraud warning graphic explaining that Medicare will never call asking for your Medicare number
Medicare will never call unexpectedly asking for your Medicare number

Unfortunately, scammers often take advantage of situations like this.

Please remember that Medicare will never do any of the following:

  • Call you unexpectedly to ask for your Medicare number
  • Charge you for a replacement card
  • Ask for banking information to send a new card
  • Threaten that your coverage will be cancelled unless you respond immediately
  • Send plastic or chip Medicare cards

IMPORTANT: If someone contacts you and asks for personal information related to your Medicare card, it is very likely a scam.

How To Recognize An Official Medicare Mailing

An official Medicare mailing does the following:

  • Arrives by postal mail
  • Does not request payment
  • Does not ask for banking information
  • Includes your name exactly as shown on your Medicare card
  • Does not require immediate action to keep your coverage active

If something feels urgent or requests personal information, it is best to verify it before responding.

What Should You Do If You Receive a Suspicious Call

If you receive a suspicious call about Medicare, the safest step is to contact Medicare directly at (800) MEDICARE to confirm whether the request is legitimate. You are also welcome to contact me if you would like help reviewing anything you receive.

Where To Learn More About Medicare Fraud Prevention

If you would like additional information about how to protect yourself from Medicare fraud, these official resources can help:

Medicare fraud prevention information
https://www.medicare.gov/fraud

Senior Medicare Patrol assistance program
https://www.smpresource.org

These trusted sources explain warning signs and what steps to take if something does not seem right.

My Recommendation to Clients

If anyone contacts you about your Medicare card and you are unsure what to do, it is always best to verify the request before responding. Protecting your Medicare information helps prevent fraud and keeps your coverage secure.

If you ever receive a Medicare related notice and are unsure whether it applies to your coverage, I am always happy to help review it with you.

About the Author

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, and several other states. I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, the Medicare Supplement Birthday Rule allows policyholders to change their plans each year without medical underwriting, and I regularly help clients lower their premiums while keeping the same identical plan and coverage. Many of my clients have saved hundreds, and sometimes thousands, of dollars.

There is no charge for my services because I am compensated by the insurance carriers, not my clients. My goal is to help you find competitive premiums and provide dependable personal service year after year.

If you are turning 65 soon, or if you already have a Medicare Supplement plan and would like to review your options, I am happy to help.

You can also click here to read what my clients have to say about working with me.

Serving Medicare clients throughout California, Nevada, and several other states.

Ron Lewis
Licensed Insurance Agent

(760) 525-5769 – Cell
(866) 718-1600 – Toll-free
Ron@RonLewisInsurance.com
www.MedigapShopper.com

CA Insurance License: #0B33674
NV Insurance License: #3822123
AZ Insurance License: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.

The California Medicare Birthday Rule: How Seniors Can Switch Medicare Supplement Plans Without Health Questions

Many seniors in California do not realize they have a special opportunity each year to change their Medicare Supplement plan without answering health questions. This opportunity is called the California Birthday Rule and it can be a valuable way to adjust coverage or reduce premiums if your needs have changed. Even if you are happy with your current plan, understanding the birthday rule can help you or someone you know make the most informed decisions about Medicare coverage.

What Is the California Birthday Rule?

The California Birthday Rule allows Medicare beneficiaries who are already enrolled in a Medicare Supplement plan to switch to a different Medigap plan during a specific time period each year without answering health questions or undergoing medical underwriting. Medical underwriting usually requires insurance companies to review your health history before approving a plan. If you have certain health conditions, you might be denied coverage or charged higher premiums. The birthday rule removes that barrier and gives seniors more flexibility.

Who Qualifies for the Birthday Rule?

To use the California Birthday Rule:

  • You must live in California
  • You must already have a Medicare Supplement plan
  • You can only use the rule during the 60 days following your birthday each year

During this window you can switch to a different Medigap plan with “equal or fewer” benefits. For example, someone could switch from Plan G to Plan G or from Plan G to Plan N. You cannot use this rule to switch from a plan with fewer benefits, such as Plan N, to a plan with greater benefits, such as Plan G.

Why This Rule Matters

The birthday rule can be very helpful for seniors who want to reduce their monthly premiums, adjust coverage to better match their current health needs, or gain more predictable out-of-pocket costs. Without this rule, switching plans outside of your initial Medigap enrollment period may require medical underwriting, which can limit your options or increase costs. Even if you are satisfied with your current plan, knowing about the birthday rule ensures that you or someone you know is aware of all available options.

By reviewing available plans, I can often save clients hundreds and sometimes even thousands of dollars on their premiums each year.

How to Use the California Birthday Rule

  1. Mark your calendar because the rule applies during the 60 days following your birthday
  2. Review available Medigap plans to compare premiums and coverage
  3. Contact your insurance agent or insurance company to let them know you want to use the birthday rule to switch plans
  4. Complete the application because no health questions will be asked
  5. Confirm your coverage to make sure your new plan starts as expected

Planning ahead helps ensure you do not miss this opportunity because the window is limited.

Share This Information With Friends and Family

Many California seniors are unaware of the California Birthday Rule. Sharing this information with friends, family, or neighbors can help them avoid being denied coverage due to health conditions, reduce their premiums, or get a plan that better suits their needs. Providing this information is a valuable way to help others understand their Medicare options.

Need Help Understanding Your Options

Medicare rules can be confusing and every situation is a little different. If you or someone you know has a Medicare Supplement plan and wants to understand how the California Birthday Rule can help, I am always happy to answer questions and review options. Please feel free to share this article with friends or family who might benefit. Helping people understand their Medicare coverage is one of the most valuable things I can do for my clients.

Have Questions About Your Medicare Supplement Plan?

I’m here to help you understand your options and make the most of the California Birthday Rule. By reviewing available plans, I can often save clients hundreds and sometimes even thousands of dollars on their premiums each year.

If you found this article helpful, please feel free to share it with friends or family members who may have questions about their Medicare coverage.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Why Seniors Are Leaving Medicare Advantage Plans

Over the past several years, Medicare Advantage (MA) plans have become very popular. Millions of Americans have enrolled in them, often because the plans advertise low premiums and extra benefits such as dental, vision, or gym memberships.

However, a growing number of seniors are discovering that MA plans are not always the best fit for their healthcare needs. In fact, many people eventually decide to leave MA plans and return to Original Medicare (Part A and Part B), often paired with a Medicare Supplement (Medigap) plan.

If you or someone you know currently has an MA plan, it may be helpful to understand why some seniors decide to switch back. The goal of this article is not to criticize MA plans, but rather to explain some of the most common reasons people reconsider their coverage after experiencing it firsthand.

Below are several key reasons why some seniors choose to leave MA plans.

1. Doctor and Hospital Networks Can Be Limiting

One of the biggest differences between MA plans and Original Medicare is the use of provider networks. Most MA plans are HMOs and some are PPOs. This means members typically must receive care from doctors and hospitals within the plan’s network in order to receive the lowest cost coverage. While some plans offer limited out-of-network benefits, they are often more expensive.

Many people don’t realize how restrictive these networks can be until they actually need medical care. For example, a doctor you have seen for years may not be included in the plan’s network. Even more frustrating, doctors and hospitals can leave networks from one year to the next, meaning your trusted provider may suddenly no longer be covered.

Original Medicare works very differently. Patients can generally see ANY doctor or hospital in the United States that accepts Medicare, which includes the vast majority of providers, approximately 93%. For seniors who value flexibility and freedom in choosing their healthcare providers, this can be a major advantage.

2. Prior Authorization Requirements

Another issue that sometimes surprises MA members is the requirement for prior authorization. Prior authorization means the insurance company must approve certain procedures, tests, or treatments before they are performed. While this process is intended to control costs and ensure appropriate care, it can sometimes lead to delays or complications. For example, a physician may recommend a particular diagnostic test or treatment, but the MA plan may require additional approval before the service is covered. In some cases, this can delay care while paperwork is reviewed.

Original Medicare generally does not require prior authorization for most medically necessary services. This can make the process of receiving care simpler and more straightforward for patients and their doctors.

3. Referrals to Specialists

Most MA plans require members to obtain referrals before seeing a specialist. This means that if you want to see a cardiologist, dermatologist, or other specialist, you may first need to visit your primary care physician and obtain a referral. While some people are comfortable with this system, others find it inconvenient.

With Original Medicare, referrals are typically not required. Patients can schedule appointments with specialists directly, provided the specialist accepts Medicare. For seniors who want greater control over their healthcare decisions, this difference can become an important factor.

4. Coverage When Traveling

Travel is another area where some MA members encounter unexpected limitations. Many MA plans are designed around regional networks. If you travel outside your local area for an extended period of time, you may find that accessing routine medical care becomes more complicated.

While emergency care is usually covered nationwide, non-emergency services may be limited to the plan’s network. Original Medicare, on the other hand, is accepted by doctors and hospitals across the country. This makes it much easier for retirees who travel frequently, spend part of the year in another state, or simply want peace of mind while away from home.

5. Costs Can Be Less Predictable

MA plans often advertise low monthly premiums, and in some cases the premium may even be zero. While this can sound very appealing, it’s important to look at the total potential cost of care.

Many MA plans require co-payments for services such as:

  • Doctor visits
  • Specialist visits
  • Diagnostic tests
  • Outpatient procedures
  • Hospital stays

These costs can add up quickly if someone experiences serious health issues. In contrast, many people who choose Original Medicare also purchase a Medicare Supplement plan. These plans help cover many of the out-of-pocket expenses that Original Medicare does not pay, such as deductibles and coinsurance. As a result, healthcare costs can be more predictable from year to year.

6. MA Plans Have Maximum Out-of-Pocket Limits

Another factor many people overlook is the maximum out-of-pocket limit in MA plans. Each MA plan must set a maximum amount that a member could potentially pay during the calendar year for covered medical services. In 2026, that limit can be as high as $9,350 for in-network services, although some plans may set lower limits.

IMPORTANT: If you go out of network, you usually pay all costs!

While reaching that amount may not happen every year, it is possible if someone experiences a serious illness, hospitalization, or multiple medical procedures during the year. Also, if someone gets seriously ill in the last part of the year and they have met their annual deductible but are still requiring expensive care in the beginning of the following year, their annual deductible starts all over again every January, and they could potentially have to pay $9,350, etc. twice in a 12 month period!

By comparison, many people who combine Original Medicare with a comprehensive Medicare Supplement plan have much lower out-of-pocket exposure for Medicare-approved services. This can make healthcare costs far more predictable for retirees who want peace of mind. For example, with a Plan G Medicare Supplement, the maximum out-of-pocket cost for all of 2026 is the Medicare Part B deductible, which is only $283.

7. Switching Back Can Be Difficult Later

One of the most important facts many people don’t realize is that switching from MA to a Medicare Supplement plan later in life can sometimes be difficult.

When people first enroll in Medicare, they have a six-month Medicare Supplement open enrollment period. During this time, they can purchase any Medicare Supplement plan that they want without answering health questions. However, if someone decides to leave an MA plan later and apply for a Medicare Supplement plan, they are required to go through medical underwriting in most states. This means the insurance company can review health history and potentially decline coverage.

Because of this rule, some people feel “stuck” in their MA plan if their health has changed over time. There are a few exceptions in certain states that provide additional consumer protections, but the rules can vary significantly depending on where someone lives.

Making an Informed Decision

It is important to understand that both MA and Original Medicare with a Medicare Supplement plan can be appropriate depending on an individual’s preferences, budget, and healthcare needs.

Some people are perfectly happy with their MA plan and appreciate the additional benefits and lower premiums. Others prefer the flexibility and predictability offered by Original Medicare combined with a Medicare Supplement. The key is making an informed decision and understanding how the two types of coverage work before enrolling.

Final Thoughts

Healthcare coverage is one of the most important decisions people make during retirement. While MA plans work well for some individuals, others eventually decide that the flexibility and simplicity of Original Medicare better meets their needs.

If you have friends or family members enrolled in an MA plan who are experiencing frustrations with networks, referrals, or prior authorization requirements, it may be helpful for them to learn about the differences between these options. Everyone’s situation is unique, and the best coverage depends on personal circumstances. However, understanding how Medicare works can help seniors make confident decisions about their healthcare coverage for the future.

If you or someone you know currently has an MA plan and would like to better understand how it compares to Original Medicare with a Medicare Supplement plan, feel free to contact me. I’m an independent Medicare agent and I’m happy to help you review your options.

And if you found this article helpful, please feel free to share it with friends or family members who may have questions about their Medicare coverage.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Why You Should Contact HICAP for Help Choosing a Medicare Prescription Drug Plan

Choosing a Medicare Prescription Drug Plan (PDP), which is also known as Part D, can feel overwhelming. With dozens of plans available, each with different premiums, deductibles, copays, and pharmacy networks, it’s easy to make a costly mistake.

As a Medicare Supplement (Medigap) insurance agent, I often get questions from clients who also want help selecting a Part D plan. While I’d love to help, I recently learned that helping someone choose or enroll in a Part D plan without proper certification could put my insurance license at risk. However, there’s a better option that is free, unbiased, and comprehensive through the Health Insurance Counseling and Advocacy Program (HICAP).

Many Insurance Agents Have Stopped Selling Prescription Drug Plans

If you’ve noticed that fewer independent agents are offering Medicare Prescription Drug (Part D) plans, you’re not imagining things. Over the past couple of years, the Centers for Medicare & Medicaid Services (CMS) has introduced an increasing number of onerous regulations that have made it extremely difficult for many agents to continue offering these plans, especially independent agents who value personal service and client relationships.

For example, CMS recently began requiring insurance agents to record every marketing, sales, and enrollment call related to Medicare Prescription Drug Plans (Part D). This means any discussion involving benefits, costs, or plan comparisons must be recorded, both inbound and outbound, and those recordings must be securely stored for 10 years. Agents don’t like this and many Medicare beneficiaries don’t want their conversations recorded.

While these rules were intended to protect consumers from misleading marketing, the burden of compliance has become overwhelming for many professionals in the field. For more detailed information, please click here to check out my other blog called “Why Many Insurance Agents Have Stopped Selling Prescription Drug and Advantage Plans,” and click here to to check out another related blog called “Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D).”

Why an Insurance Agent Might Not Be Enough

Many insurance agents are only certified to sell PDP’s from certain insurance carriers, which means:

  • They may not have access to every plan available in your area.
  • Their guidance could be influenced by commissions or appointments, even unintentionally.
  • You may not get a complete picture of your options, which can lead to higher costs or gaps in coverage.

That’s where HICAP comes in.

What is HICAP and How It Helps

The Health Insurance Counseling and Advocacy Program (HICAP) is a free, state-run program in California that provides free, confidential one-on-one counseling, education, and assistance to individuals and their families on Medicare, Long-Term Care insurance, other health insurance related issues, and planning ahead for Long-Term Care needs.

HICAP also provides legal assistance or legal referrals in dealing with Medicare or Long-Term Care insurance related issues. HICAP counselors are trained in Medi-Cal and Medicare and can help you understand the complex insurance options to find the best fit for you.

HICAP counselors:

  • Can show all available Part D plans in your area.
  • Provide completely unbiased guidance, with no sales pressure.
  • Help you compare costs, deductibles, co-pays, and pharmacy networks.
  • Walk you through the Medicare Plan Finder tool or help you understand your plan options.

What HICAP Services Are Available?

HICAP can help you with the following:

  • Have questions on prescription drug coverage, co-pays, or eligibility rules?
  • Wondering how to sign up for Medicare now that you are almost 65?
  • Confused about all the different parts to Medicare, do you need A, B, C, D?
  • Need help filing an appeal or challenging a denial?
  • Considering long-term care insurance?
  • Need a speaker for a community education event?

How a HICAP Session Works

Whether over the phone or in person, the process is simple:

  • Prepare your information: Have a list of all your prescriptions, your preferred pharmacy, and your zip code.
  • Enter your own prescriptions: You input your medication information into Medicare.gov.
  • Guided support: The HICAP counselor explains your options, interprets plan details, and answers questions.
  • Compare plans: They help you see which plan offers the best coverage for your needs.
  • Enrollment: You complete the enrollment yourself online or by calling the plan.

Who Can Get These Services?

Counseling is provided to the following individuals:

  • Persons 65 years of age or older and are eligible for Medicare
  • Persons younger than age 65 years of age with a disability and are eligible for Medicare
  • Persons soon to be eligible for Medicare

Why HICAP is the Best Choice

HICAP counselors provide a full picture of your options, which an insurance agent cannot always do. Their guidance is independent, comprehensive, and free. This ensures you make an informed decision about your prescription coverage without missing important details or paying more than necessary.

Check Out My Video — How to Sign Up for a PDP on the Medicare Website

This past year, I created a step-by-step YouTube video that shows you how to use the Medicare Plan Finder tool. Nothing has changed since last year. Instead of contacting a HICAP counselor, you should be able to watch the video and be able to select a PDP and enroll on your own. It’s really very easy! Please click here to watch the video. It’s only 14 minutes long.

Next Steps

If you’re ready to compare Medicare Prescription Drug Plans for 2026:

  • Click here to watch my Youtube video that explains how to to use the Medicare Plan Finder tool to select a PDP and enroll on your own.
  • Call HICAP at 1-800-434-0222 or click here to find a local office in California.
  • In other states besides California, you can get help at your local State Health Insurance Assistance Program (SHIP). Their phone number is 1-877-839-2675 or click here to find a local office outside of California.

And if you have questions about Medicare Supplement (Medigap) plans, I’m here to help guide you through your options.

Conclusion

Choosing a Part D plan doesn’t have to be stressful. By using HICAP’s free, unbiased services, you can get all the information you need to make the best decision for your health and budget, while staying in control of the process.

About the Author

As an independent Medicare Supplement insurance specialist, I work with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t do a magic act and disappear after you sign up! 🙂

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Switching from Medicare Advantage to Medigap in California: What You Need to Know

Each year, many people in California decide to leave their Medicare Advantage (Part C) plan and return to Original Medicare (Part A and Part B) with a Medicare Supplement (Medigap) plan. Often, this happens when premiums, copays, or out-of-pocket costs increase, or when clients find their favorite doctors or hospitals are no longer in their plan’s network.

If you’ve ever wondered how to switch from Medicare Advantage to Medigap, it’s important to understand how the process works, and the potential challenges if you have existing health conditions.

You Can Switch Back to Original Medicare — But You’re Not Automatically Guaranteed Medigap Approval

You can drop your Medicare Advantage plan and go back to Original Medicare during certain times of the year, such as the Annual Election Period (AEP), which goes from October 15th through December 7th every year or during the Medicare Advantage Open Enrollment Period, which goes from January 1st through March 31st.

However, many people are surprised to learn that once they return to Original Medicare, they must apply separately for a Medicare Supplement plan, and approval is not guaranteed. In most cases, insurance companies can review your health history, which is called “medical underwriting,” and deny coverage if you have serious or chronic health conditions. That’s why timing and knowing the rules can make all the difference.

Medicare Guaranteed Issue Rights: The Hidden Opportunities

Here’s the good news… even if you have health problems, there are special Guaranteed Issue (GI) rights or situations that often let you enroll in a Medigap plan without health questions or underwriting.

These rights apply in specific situations and many beneficiaries don’t realize they qualify. Some are tied to Medicare Advantage plan changes, others to state-specific protections. In California, there are several lesser-known GI opportunities that can help people switch to Medigap coverage, even when they’ve been told “no” before.

I work with clients every year who thought they couldn’t qualify due to health issues and I’ve helped them get accepted for Medicare Supplement coverage using legitimate Guaranteed Issue options that most agents aren’t aware of or don’t mention to their clients.

Why Work with a Specialist Who Knows the California Rules

The Medicare rules in California are unique. Between the California Birthday Rule and other state-specific guaranteed issue protections, there are several ways to save money and secure coverage without medical underwriting.

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. My goal is simple. I want to help you find the best Medicare Supplement plan with the lowest premium and the most reliable coverage, year after year.

Let’s See What You Qualify For

If you’re considering leaving your Medicare Advantage plan or want to see if you qualify for a Guaranteed Issue Medicare Supplement, don’t wait until it’s too late.

There is no cost for my help. I’m paid by the insurance carriers, not my clients. I can review your situation, identify any Guaranteed Issue opportunities, and help you apply for the coverage that fits your needs and budget.

Contact me today to learn your options and see how much you could save on your Medicare Supplement plan.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars for the same exact plan and coverage! Please click here to read what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Why Many Insurance Agents Have Stopped Selling Prescription Drug and Advantage Plans

If you’ve noticed that fewer independent agents are offering Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans, you’re not imagining things. Over the past couple of years, the Centers for Medicare & Medicaid Services (CMS) has introduced an increasing number of onerous regulations that have made it extremely difficult for many agents to continue offering these plans, especially independent agents who value personal service and client relationships.

While these rules were intended to protect consumers from misleading marketing, the burden of compliance has become overwhelming for many professionals in the field. Here’s a closer look at what’s changed and why it’s causing so many agents to step back.

The Call Recording Requirement

Perhaps the biggest change came when CMS began requiring agents and brokers to record every marketing, sales, and enrollment call related to Medicare Advantage plans (Part C) and Medicare Prescription Drug Plans (Part D). This means any discussion involving benefits, costs, or plan comparisons must be recorded, both inbound and outbound, and those recordings must be securely stored for 10 years.

That might sound simple, but for independent agents, it’s a major operational and financial challenge. Recording, encrypting, and storing every call securely requires specialized technology, data security systems, and compliance audits. If even one recording goes missing, an agent could face serious penalties. For small agencies and independent brokers, this rule alone has made it nearly impossible to operate efficiently.

Please click here for more specific details regarding marketing policies and FAQs for selling Medicare prescription drug and Medicare Advantage plans.

Increased Compliance and Oversight

CMS now classifies many independent agents and marketing organizations as Third-Party Marketing Organizations (TPMOs). Under these rules, agents must read lengthy government disclaimers at the start of every call or meeting, document every contact, and ensure all marketing materials are CMS-approved before use.

This includes websites, flyers, emails, and even social media posts that mention Medicare Advantage or Medicare Prescription Drug plans. Every piece of material must be filed through a formal process for review, which can take weeks. This makes it difficult for agents to respond quickly to client questions or market changes during the short Annual Election Period (AEP), which goes from October 15th through December 7th each year.

More Work, Less Reward

Despite the added workload and responsibility, commissions have not increased to reflect these changes. Agents still receive modest compensation for enrolling people in Medicare Prescription Drug plans and Medicare Advantage plans. So now, agents face hours of compliance documentation, call recording, and potential liability without a corresponding increase in pay. For many, it simply isn’t worth the time, risk, or stress. For more details, please click here to read my other blog called “Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D)”

The Risk of Liability

Another issue driving agents away is the potential legal exposure. With every recorded call and piece of marketing material subject to audit, a single accidental error, like forgetting to read a required disclaimer, can lead to fines or the loss of certification.

Most agents take pride in helping clients find the best coverage possible, but with these new rules, even honest mistakes can be costly. It’s a high-stress environment for people who genuinely care about their clients.

A Shift Back to Personalized Service

Because of all this, many experienced agents are now focusing primarily on Medicare Supplement (Medigap) plans. These plans are not part of the CMS marketing system that governs Medicare Advantage and Prescription Drug plans, which means agents can provide clients with more individualized service and guidance without jumping through as many regulatory hoops.

With Medigap plans, clients get lifelong coverage that works seamlessly with Original Medicare, and agents can continue to provide the personalized advice and service that has always been the heart of this profession.

What This Means for You

If you are a Medicare beneficiary, you might notice fewer agents offering to review your Medicare Prescription Drug plans or Medicare Advantage plans this year. It’s not because they don’t care… it’s because the rules have made it nearly impossible to do so efficiently or profitably while still providing the level of service clients deserve.

The good news is that you can still review and compare these plans directly on the Medicare.gov website. The site allows you to enter your prescriptions, preferred pharmacies, and ZIP code to find the most cost-effective options in your area.

IMPORTANT: Medicare Prescription Drug plans and Medicare Advantage plans are annual contracts and they can change from year to year. What’s good this year may not be so good next year and it’s important to shop around every year!

Shopping for and signing up for a prescription drug plan isn’t difficult. I made a short video this past year that explains how to choose and sign up for a prescription drug plan. If you’d like to watch the video, please click here.

Final Thoughts

The Medicare program is complex and constantly changing. Most agents truly want to help people understand their options, but the ever-growing CMS compliance burden has pushed many out of this side of the business.

Although I’m an independent insurance agent focusing primarily on Medicare Supplement insurance, if you’re looking for unbiased help reviewing your options, please don’t hesitate to reach out. Even though I don’t sell Medicare Prescription Drug plans or Medicare Advantage plans, I’m happy to help you understand how they work and guide you toward resources that can help you make the best decision for your needs.

In my next post, I’ll explain why many Medicare beneficiaries are actually better off by NOT using an insurance agent to help them select their Medicare Prescription Drug plan and how they can easily and safely select a drug plan on their own using the Medicare.gov website.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds—even thousands—of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services; I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D)

If you’ve ever tried to compare Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D, you know how confusing it can be. There are dozens of options, and each plan has its own list of covered drugs (called a formulary), preferred pharmacies, and cost structure. What looks like a small difference in co-pays or premiums can easily add up to hundreds of dollars over the course of a year.

Why Most Agents No Longer Sell Prescription Drug Plans

You might assume that a licensed insurance agent can help you find the best plan, and in the past, many could. However, today’s system makes that much more difficult. Because of how Medicare’s certification and contracting rules work, most independent agents are not certified with every drug plan available in your area. They can only recommend or enroll you in a limited number of specific plans they are contracted with and certified to sell.

If another company offers a plan with lower co-pays or better coverage for your medications, your agent may not even be allowed to discuss it with you. Why? Because they don’t get paid for selling plans they’re not certified or contracted to represent. Even if they know a different plan would save you money, compliance rules and commission structures prevent them from showing it to you.

The Hidden Time and Cost Burden on Agents

Before an agent can help anyone with a PDP or a Medicare Advantage (MA) plan, they must complete extensive training and certification every year. This starts with the AHIP certification exam, which takes many agents 10–20 hours of study time to complete. The AHIP exam covers topics such as Medicare compliance, plan rules, CMS marketing guidelines, etc.

But that’s only the beginning. Agents must also spend time studying and taking individual certification exams for EVERY insurance company whose plans they want to sell. Each carrier’s certification process is different. Some require several hours of training, testing, and annual renewal. Altogether, a well-rounded agent could easily spend 50+ hours each year just keeping up with certifications before they can even begin helping clients.

Then there are the CMS compliance rules, which now require all sales calls related to PDPs and MA plans to be recorded and stored securely for 10 years! The added administrative burden and potential liability make it even less practical for agents to offer these plans, especially since commissions for prescription plans are typically under $100 per year per client. Many agents have simply decided that it’s not worth the time and effort.

How You Can Shop and Enroll in a Drug Plan On Your Own

Fortunately, Medicare makes it easy for you to shop around on your own and sign up for a prescription drug plan at www.Medicare.gov by using the exact same tool that agents use.

This past year, I put together a short video that explains how to shop for and sign up for a Medicare prescription drug plan using the Medicare Plan Finder tool. It’s actually very easy, and there aren’t any significant changes since last year. Please click here to watch the video.

The Medicare Plan Finder is available 24/7 and it is updated every fall with the latest plan information. It allows you to make an informed decision without pressure or bias, and without worrying whether your agent is certified to sell a particular plan.

Review Your Coverage Each Fall

Even if you’re happy with your current PDP, it’s important to review your coverage each year during the Annual Election Period (AEP), which goes from October 15th through December 7th each year. PDPs are annual contracts, and drug prices, plan premiums, and pharmacy networks can change every year. What’s good this year may not be so good next year.

It only takes about 15 to 20 minutes to shop around and review your PDP options, and it could save you literally hundreds of dollars and ensure you have the right coverage for your specific prescriptions.

The Bottom Line

Most Medicare agents are honest, hardworking professionals who want to help their clients, but the system is stacked against them when it comes to prescription drug plans. Between certification costs, compliance rules, and low commissions, many agents have chosen to focus on Medicare Supplements, Medicare Advantage plans, or other types of insurance products instead.

By learning how to shop for your own prescription drug coverage at Medicare.gov, you can take control of your health care costs, stay informed, and make sure you’re always getting the best prescription drug plan every year.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible—year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

How the California Birthday Rule Can Save You Hundreds on Your Medigap Plan — Every Year

Introduction

If you’re a Medicare Supplement (Medigap) policyholder living in California, there’s a little-known benefit that could save you hundreds (or even thousands) of dollars a year and many people don’t even know that it exists. It’s called the California Birthday Rule, and it gives you the right to switch your Medigap plan every year around your birthday, REGARDLESS OF YOUR HEALTH!

IMPORTANT: You can change your Medicare Supplement any time of the year, but if you do it around your birthday, it’s a lot easier because you don’t have to answer any health questions, there’s no medical underwriting, and YOU CAN’T BE TURNED DOWN FOR COVERAGE!

Medigap Plans Are Standardized

Nationwide, there are 10 standardized Medicare Supplement lettered plans to choose from, Plan A through Plan N. When I say “standardized,” that means that the coverage and benefits for every lettered plan are exactly the same regardless of what insurance carrier you sign up with. In other words, Plan G is Plan G, Plan N is Plan N, etc., regardless of what insurance carrier you are with. So it’s much easier to compare plans since every plan is exactly the same no matter which insurance carrier offers it.

NOTE: Technically, there are actually 12 standardized Medigap plans to choose from because there are high-deductible versions of Plan F and Plan G. In 2025, you will pay a $2,870 deductible before your coverage for either of these plans would begin.

As you can see, the only difference between Plan F and Plan G is the Medicare Part B deductible.

Which Medigap Plan is Best?

For those who are turning 65 or starting Medicare today, the best and most comprehensive Medigap plan is Plan G, which pays for everything except for the Medicare Part B deductible. The current annual Part B deductible (in 2025) is $257. That amount can change from year to year, but historically, it hasn’t changed by much.

Medicare Access and CHIP Reauthorization Act of 2015

Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap Plan C and Plan F were discontinued for new Medicare beneficiaries starting on January 1st, 2020. This legislation eliminated the availability of Medigap plans that cover the Medicare Part B deductible for individuals who became eligible for Medicare on or after that date. However, Plan C and Plan F are still available for people who were eligible for Medicare before 2020 or who already have one of those plans. They just aren’t available for those individuals that turned 65 or started Medicare on or after January 1st, 2020.

Let’s look at a common example of how switching under the Birthday Rule can save you money.

Why Plan G is More Popular Than Plan F

If you have a Plan F Medicare Supplement, you’re probably paying more than you need to. It’s usually much cheaper and more cost effective to switch to Plan G because both plans are identical in coverage except for the Medicare Part B deductible, which is $257 in 2025. Plan F covers that small deductible, while Plan G does not. That is the only difference between the two plans, yet the premiums for Plan F are usually significantly higher.

Even though Plan F covers that $257, it often costs $400–$1,000 more per year in premiums than Plan G, so in most cases, you’d save money by paying the lower monthly premium for Plan G and just covering that $257 deductible yourself.

IMPORTANT: If you can save more than $257 per year by switching from Plan F to Plan G, then Plan G is cheaper and more cost effective.

For example, if your Plan F premium is $250 per month and you can get Plan G for $200 per month, that’s a gross savings of $50 per month or $600 per year. If you pay the $257 on your own, your net savings will still be $343 per year ($600 – $257 = $343)! The Medicare Part B deductible is payable only one time per calendar year, so after you pay that small deductible, there is absolutely no difference between Plan F and Plan G for the remainder of the year!

NOTE: If you have Plan F and you switch to Plan G, if you’ve already met your $257 Part B deductible, you won’t pay it again until the following year since that small deductible is payable only one time per calendar year.

What Is the California Birthday Rule?

The California Birthday Rule is a special California state law that allows active Medigap policyholders in California to switch to a new Medigap plan with “equal or fewer” benefits every year around their birthday without medical underwriting during a 60-days following their birthday.

NOTE: In California, most carriers accept applications from 30 days before your birthday up to 60 days after your birthday, a 91-day window to switch Medigap plans without medical underwriting.

Most states don’t have a birthday rule, and if you develop a serious health condition, you could be stuck with your current health insurer and Medigap plan. But thanks to the California Birthday Rule, you have a guaranteed open enrollment period every year to shop around and save money on your premiums without worrying about being stuck or declined.

What Does Equal or Fewer Mean?

Again, under the birthday rule, you can switch to any Medigap plan that offers “equal or fewer” benefits than your current plan. In other words, you can switch from your current Medigap plan to any other Medigap plan that offers benefits that are the same or less comprehensive than what you currently have.

For example:

  • You cannot upgrade to a plan with more benefits (such as Plan N to Plan G).
  • You can switch to a plan with the same level of benefits (such as Plan G to another Plan G with a different carrier).
  • You can downgrade to a plan with fewer benefits (such as Plan F to Plan G, Plan G to Plan N, etc.).

This rule exists to prevent people from waiting until they are sick to “upgrade” to more generous coverage. However, it does give you freedom to shop around for lower prices on the same or lesser coverage without worrying about health questions or being declined.

Examples of “Equal or Fewer”

  • If you have Plan F, you can switch to Plan F with a different insurance carrier or to Plan G, Plan N, etc.
  • If you have Plan G, you can switch to Plan G with another insurance carrier or to Plan N, etc.
  • If you have Plan N, you can switch to Plan N with a different insurance carrier or to Plan A, etc.

Even if you’re not sure whether your current plan is the best deal, you can always switch to the same plan with a different insurance carrier during your birthday rule window, often saving hundreds and sometimes thousands of dollars per year without changing any of your benefits.

What States Have a Medigap Birthday Rule?

Today, more states are slowly adding their own birthday rules. Here is a current list of states that have a Medicare birthday rule:

  • California
  • Illinois
  • Idaho
  • Kentucky
  • Louisiana
  • Maryland
  • Nevada
  • Oklahoma
  • Oregon
  • Utah
  • Virginia
  • Wyoming

States with Year-Round Guaranteed Issue or Open Enrollment Rights

These states don’t have a Medicare birthday rule, but they offer year-round guaranteed issue or open enrollment periods without underwriting:

  • Connecticut
  • Maine
  • Missouri
  • New York
  • Washington

Do Most People Use the Birthday Rule?

Surprisingly, no! Many people don’t know this rule exists and they stay on overpriced Medigap plans for years thinking they’re stuck because of health issues, etc. If you take advantage of the birthday rule each year, you can keep your premiums under control and avoid being overcharged.

Rates Vary Significantly Between Insurance Carriers

As mentioned before, Medigap plans are “standardized” meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits for every Plan G, etc. are exactly the same regardless of what insurance carrier you are with. However, the rates between insurance carriers are not standardized. Every insurance carrier charges their own rates.

For example, right now in the 92024 zip code (San Diego), the Plan G rates for a 70 year old single female range from $217.78 to $319.79 per month! That’s a difference of $102.01 per month or $1,224.12 per year for the same identical plan and coverage!

NOTE: Several years ago, one of my clients, a husband and wife, moved to San Diego from Los Angeles. They were paying $809.00 per month for Plan G with United American, and I got them Plan G with Mutual of Omaha for $367.01 per month, which was a savings of $441.99 per month or $5,303.88 per year for the save identical plan and coverage! Rates are based primarily on age and zip code, and they are constantly changing. It‘s critically important to shop around every year!

How to Apply and Save Money!

To take advantage of the California birthday rule, you must do the following:

  • Live in California
  • Have an active Medigap plan
  • Switch to a Medigap plan with “equal or fewer” benefits
  • Apply during the 30 days before up to 60 days after your birthday
  • Email me at Ron@RonLewisInsurance.com or call me at 760.525.5769 (cell) or 866.718.1600 (toll-free) for a free quote or to switch plans

It only takes a few minutes to apply and there is never a charge for my service!

Conclusion

If you currently have a Medigap plan, you can change your plan every year around your birthday, REGARDLESS OF YOUR HEALTH! If you apply during your annual 60-day open enrollment period under the California Birthday Rule, YOU CANNOT BE TURNED DOWN FOR COVERAGE!

As an independent insurance agent specializing in Medicare Supplements, I work with all the major insurance carriers, not just one. (A “captive” insurance agent can only represent one insurance carrier.) I will do the shopping for you and find you the best rates, not just this year, but I shop around for all my clients every year around their birthday! The monthly premiums are exactly the same whether you let me do the shopping for you to save you money on your premiums or if you contact an insurance carrier directly! Please visit Client Testimonials to read what some of my clients have to say about me.

Call, text, or email me today, and I’ll help you review your options in just a few minutes with no pressure or obligation. Let me help you save hundreds, or even thousands of dollars, on the exact same Medigap plan you already have. Won’t that be a nice birthday present?

If you liked this blog and found it informative, please click the “Like” button, and please send me your questions, comments, or feedback! And please feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Medicare Fraud Awareness: Protect Yourself and Your Benefits

Medicare fraud is a serious issue that affects millions of Americans each year, and it costs taxpayers billions of dollars. Fraudulent activities not only waste valuable resources but can also put your personal health information at risk. This article takes a closer look at Medicare fraud, how to recognize it, and what you can do to protect yourself.

What is Medicare Fraud?

Medicare fraud occurs when someone intentionally misleads or deceives Medicare for financial gain. Here are some examples:

  • Billing for services you didn’t receive: Providers may bill Medicare for treatments, tests, or procedures that you didn’t actually receive.
  • Falsifying diagnoses or treatments: Some fraudulent providers might fabricate medical records to justify unnecessary treatments or prescriptions.
  • Unnecessary tests or treatments: Some providers might encourage you to undergo tests or treatments that are unnecessary, just so they can bill Medicare for them.
  • Medicare card theft: Fraudsters may steal your Medicare card to use it for unauthorized services or sell it to others.

How to Identify Medicare Fraud

It’s important to stay vigilant and be aware of potential fraud. Here are a few red flags to watch out for:

  • Unsolicited Calls or Visits: Be wary of phone calls or home visits from people who say they’re from Medicare or healthcare companies, especially if they are asking for your personal information. Medicare will never call you without reason to request personal information.
  • Offers of “Free” Services: If someone offers you “free” services in exchange for your Medicare number, that’s a huge red flag. While some services are covered by Medicare, be cautious about anything that sounds too good to be true.
  • Incorrect or Unfamiliar Charges: Always review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). If you see charges for services you didn’t receive, contact the provider immediately.
  • Pressure to Join a Plan or Buy a Product: Scammers may pressure you to sign up for a plan or buy a product that you don’t need. Take your time to make decisions and consult with a trusted advisor if needed.

How to Protect Yourself From Medicare Fraud?

Here are some ways to protect yourself from Medicare Fraud:

  • Safeguard Your Medicare Number: Treat your Medicare card like a credit card. Don’t share it with anyone except your trusted healthcare providers.
  • Be Informed: Know what services and treatments are covered by your Medicare plan. Review your benefits regularly and ask questions if something doesn’t seem right.
  • Keep Track of Your Medical Bills: Stay organized by keeping records of your appointments, prescriptions, and any medical services you receive. This will make it easier to spot discrepancies on your billing statements.
  • Report Suspected Fraud: If you believe you’ve been a victim of Medicare fraud or notice suspicious activity, don’t hesitate to report it to:
    • Medicare: Call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.
    • The Department of Health and Human Services Office of Inspector General (OIG): You can file a report online at oig.hhs.gov.

What Happens After Reporting?

Once a fraud case is reported, Medicare’s fraud prevention team will investigate the issue. If fraudulent activity is found, it could result in fines, loss of provider licenses, or even criminal charges against the perpetrator. Additionally, reporting helps Medicare improve fraud detection measures to protect other beneficiaries.

Final Thoughts

Medicare fraud is a real threat, but with awareness and vigilance, you can protect yourself and your healthcare benefits. Always question anything that seems suspicious and don’t hesitate to report anything unusual. Your attention to detail can help stop fraud and safeguard your Medicare benefits.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Ace Property and Casualty, AFLAC, Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc.

I have hundreds of clients, and I shop around for them every year. Please click here to see some of my client testimonials.

FINAL TIP: If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to call me or send me an email! Also, please feel free to forward this blog to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Medicare Advantage Plans – Do the Advantages Outweigh the Disadvantages?

The Annual Election Period (AEP) is from October 15th through December 7th each year. During this annual open enrollment period, you can sign up for or change your Medicare Advantage (MA) plan or your Prescription Drug Plan (PDP). Medicare Advantage and prescription drug plans are annual contracts, and they can change from year to year. Therefore, you should shop around and compare plans every year.

NOTE: If you have a Medicare Supplement, the AEP does not apply to you unless you want to enroll in or change your PDP.

If you have an MA plan and you want to change to a different MA plan, or if you want to leave your MA plan and switch back to Original Medicare, Part A (Hospital insurance) and Part B (Medical insurance), you would normally do so during the AEP. The new coverage will begin on January 1st of the following year. In most cases, you must stay enrolled in your MA plan for the calendar year beginning in January or on the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop an MA plan during a Special Enrollment Period (SEP), such as if you move out of your plan’s service area, etc.

open-enrollment

Pros and Cons – Medicare Supplements Versus Medicare Advantage Plans

When it comes to Medicare Advantage (MA) plans, I’m going to be totally honest and admit to you that I am biased because I don’t like them! Unless you can’t afford to pay the monthly premium for a Medicare Supplement (aka Medigap), I would NEVER recommend or advise someone to give up their Original Medicare rights (Part A and Part B) and sign up for an MA plan!

If you currently have an MA plan, or if you are thinking about signing up for one, I would strongly recommend that you read this article first so that you can make an “informed decision” about whether an MA plan is right for you and in your best interest.

There are pros and cons to each, but the benefits of having a Medicare Supplement plan far outweigh the benefits of having an MA plan. Please click here for a detailed comparison between Original Medicare and Medicare Advantage plans.

medicare-advantage-vs-medigap-boxes

MA Plan Advantages

Here are some of the benefits of having an MA plan:

  • MA premiums can be very low, and some plans have no monthly premiums at all.
  • Some MA plans include Medicare prescription drug coverage (Part D).
  • Maximum out-of-pocket (OOP) costs are limited. Plans vary, but in 2025, the most you can pay for in-network OOP costs is $9,350 per calendar year. If you go out of network, you would normally pay all costs! (I wouldn’t really call this a benefit since $9,350 is a lot of money, and the most you would pay in OOP costs with a Plan G Medicare Supplement is the Medicare Part B deductible, which is currently $240 per calendar year in 2024! The Medicare Part B deductible for 2025 is projected to be $257. However, the Centers for Medicare & Medicaid Services (CMS) will not finalize the deductible until fall 2024.)
  • Some MA plans offer additional benefits such as vision, hearing, dental, and other health and wellness programs. (Some Medicare Supplement plans also offer additional benefits such as free gym memberships, vision, and hearing aid benefits.)

Medicare Supplement Plan Advantages

Here are some of the benefits of having a Medicare Supplement plan:

  • You have much more FREEDOM of choice with a Medicare Supplement than you do with an MA plan because you can go to ANY doctor, hospital, specialist, care facility, etc. in the United States as long as they accept Medicare, and most do, about 93%. (You can’t do that with an MA plan.)
  • You have much for financial stability with a Medicare Supplement than an MA plan because there are no unexpected expenses for deductibles, co-payments, hospitalizations, surgeries, chemotherapy, etc.
  • With a Plan G Medicare Supplement, other than your premiums, your maximum OOP cost in the 2025 calendar year will be no more than the Part B deductible, which is currently projected to be around $257. With an MA plan, your in-network maximum OOP “in-network” costs can be as high as $9,350! If you go out of network, your costs can be significantly higher.

NOTE: The Medicare Part B deductible is payable only one time per calendar year. If you’ve already met that deductible, you won’t have any other costs for Medicare-approved charges for the rest of the year.

  • You are not limited to a specific geographic region or a restrictive network of doctors, hospitals, specialists, care facilities, etc. like you are with an MA plan. Most MA plans are HMO’s and you will normally pay all costs if you go out of network.
  • With a Medicare Supplement, you can go directly to the specialist of your choice, ANYWHERE in the United States, as long as they accept Medicare. Most MA plans require you to go through a primary care doctor first and get permission to see a specialist within the local, geographic network.
  • Unlike MA plans, there are no HMO or PPO plans or networks with Medicare Supplements. You can go to any doctor or specialist in the US as long as they accept Medicare.
  • If you want to go to a renowned treatment center such as the MD Anderson Cancer Treatment Center in Texas, you can do so with any Medicare Supplement, as long as they accept Medicare. You can’t do that with most MA plans.
  • If you move to another part of the country, you can keep your Medicare Supplement, but you cannot keep your MA plan if you move out of your network.
  • There are only 10 “standardized” Medicare Supplement plans to choose from,  (Plan A through Plan N). Since Medicare Supplements are standardized, the coverage and benefits for every Plan G, etc. is exactly the same with every insurance carrier, so it’s much easier to shop around and compare “apples with apples.” MA plans are not standardized, and the co-payments, deductibles, out of pocket costs, etc. vary between MA plans, and they change every year making them unnecessarily complicated and confusing.
  • A Medicare Supplement plan cannot be cancelled as long as you pay your premiums. MA plans are annual contracts, and they can be cancelled or benefits changed at the end of each calendar year.
  • There is no Annual Election Period (AEP) for Medicare Supplements, and you don’t have to shop around every year and make sure that your coverage, co-payments, co-insurance, deductibles, and benefits haven’t changed since the previous year. If there are any Medicare changes from one calendar year to the next, your Medicare Supplement will automatically pay the difference.
  • Medicare Supplements are “portable” meaning that you can keep them and take them with you if you travel to another state or if you move to another state, and your Medicare Supplement cannot be cancelled for leaving your “service area.” With most MA plans, if you travel outside of the MA plan’s service area for more than six months, you could be dis-enrolled from the plan.
  • With a Plan G Medicare Supplement, there are no co-payments when you go to the doctor. With most MA plans, you have to pay co-payments every time you see a doctor.
  • You can switch Medicare Supplement plans or Medicare insurance carriers any time of the year as long as you meet minimum health and underwriting requirements. With an MA plan, you can only join or leave an MA plan during the AEP or a SEP. Otherwise, you are locked into your MA plan for the entire calendar year.

NOTE: In California, there is a law called the California Birthday Rule. Under this law, if you have a Medicare Supplement, you can change it every year during the 60 days following your birthday to any other Medicare Supplement plan with “equal or fewer” benefits. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, regardless of your health. If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G, etc. Under the birthday rule, you just can’t switch from a plan with fewer benefits to greater benefits.

As you can see from the facts mentioned above, the benefits of having a Medicare Supplement far outweigh the benefits of having a Medicare Advantage plan.

Are Some Medicare Advantage Plans Really Free?

Because some MA plans have very low monthly premiums or no monthly premiums at all, some unscrupulous individuals promote them as “FREE” Medicare insurance plans, which is inaccurate, misleading, and, in my opinion, unethical. During the AEP, there are a lot of commercials for MA plans on TV. If you listen carefully, the one thing you’ll NEVER hear them mention is the maximum out-of-pocket costs for those plans. In 2025, in-network OOP costs can be as high as $9,350, and if you go out of network, you can pay significantly more!

Also, regardless of whether you have an MA plan or a Medicare Supplement plan, you still have to pay the monthly Medicare Part B premium, which is currently $174.70 per month for most people in 2024. The Medicare Part B premium in 2025 hasn’t been released yet, but it is estimated to be around $185.00 per month.

medicare-advantage-pig

You Can Always Get a Medicare Advantage Plan But You Can’t Always Get a Medicare Supplement Plan

MA plans are adequate as long as you are healthy, but if your health should change and you develop a serious illness, you will wish that you had a Medicare Supplement instead of an MA plan because you will have much more freedom of choice and control over your health care with a Medicare Supplement!

Original Medicare (Part A and B) only cover about 80% of medical and hospital costs and Medicare Supplements pick up most of the remaining 20%. During the AEP, you can always switch from a Medicare Supplement to an MA plan, regardless of your health, and you can always switch from an MA plan back to Original Medicare (Part A and Part B), regardless of your health. However, if you switch back from an MA plan to Original Medicare during the AEP, there is no guarantee that you can get a Medicare Supplement as you must be in good health, answer health questions, and be medically underwritten to be approved. If you have any serious health issues, more than likely, you won’t be able to get a Medicare Supplement.

NOTE: There are some situations where you can switch from an MA plan to a Medicare Supplement as a “guaranteed issue” without answering any health questions or going through medical underwriting. If you are in this situation, please let me know.

Also, if you are in the first year of your MA plan, you are guaranteed the right to switch back to a Medicare Supplement during the first 12 months. This is called a trial right. The trial period gives you a year to try an MA plan and see if it’s right for you. If you decide it’s not, you are guaranteed the right to switch back to original Medicare (Parts A and B) and purchase a Medicare Supplement plan.

The Maximum Out of Pocket Cost for MA Plans Can Be Twice As Much As You Think

Depending on which MA plan you have, the most you would pay for in-network out-of-pocket (OOP) costs in 2025 is $9,350 per calendar year! If you go outside of your plan’s network, you will pay even more than that!

Now suppose that you get really sick and need expensive treatment in the second half of the year. You could end up paying up to $9,350 (or whatever your plan’s maximum OOP cost is) by the end of the calendar year, but your OOP maximum zeros out in January, and it starts all over again! You could potentially end up paying your OOP TWICE in a 12-month period!

Conclusion

If you have an MA plan, you give up your Original Medicare (Part A and Part B) rights and you compromise your freedom of choice to go to the best doctors, specialists, hospitals, care facilities, etc. throughout the United States. Unless you are impoverished and can’t afford to pay the monthly premium for a Medicare Supplement, I would never recommend an MA plan to a friend or family member as you are always better off with a Medicare Supplement.

I’m an independent insurance agent, not a captive agent, and I work with most of the major insurance carriers. I shop around for my clients, every year, and I will shop around for you too! If you have any questions or if you have an MA plan and would like for me to help you switch to a Medicare Supplement plan, please let me know! And if you have a Medicare Supplement, I’m happy to shop around for you to save you money on your premiums!

There’s no such thing as free Medicare insurance! As the old expression goes… “You get what you pay for!”

you-get-what-you-pay-for

If you liked this blog and found it informative, please click the “Like” button, and please send me your questions, comments, or feedback! And please feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

The California Birthday Rule

If you are a California resident and you have a Medicare Supplement, aka a “Medigap” plan, I have good news for you! Under a law called the California Birthday Rule, you have 60 days of “open enrollment” following your birthday each year when you can change your Medigap plan, REGARDLESS OF YOUR HEALTH. During this period, there are no health questions to answer, no medical underwriting or waiting periods, and YOU CANNOT BE TURNED DOWN FOR COVERAGE! To qualify, the new plan must have “equal or fewer” benefits as your current policy.

For example, if you have Plan G, you can switch to Plan G with any other insurance carrier or you could switch to Plan N since Plan N has fewer benefits than Plan G. You just can’t switch from Plan N to Plan G, etc. under the birthday rule because Plan N has fewer benefits than Plan G.

NOTE: In California, most insurance carriers will let you apply during the 30 days before your birthday up to 60 days after your birthday, so in reality, you have a 90-day open enrollment period each year.

You can change your Medigap plan any time of the year, but if you do so around your birthday, it’s a lot easier because you don’t have to answer any health questions on the application and you can’t be turned down for coverage.

The Annual Election Period

There is another open enrollment period called the Annual Election Period (AEP) that goes from October 15th through December 7th every year. This open enrollment period has nothing to do with Medigap plans. It’s only for people with Medicare Advantage (MA) plans and/or Prescription Drug Plans (PDPs). If someone has an MA plan or a PDP, the AEP is the time to shop around and change those plans. The new coverage would begin on January 1st of the following year.

During the AEP, you can always switch from a Medigap plan to an MA plan, but there is no guarantee that you can switch from an MA plan to a Medigap plan. If someone has an MA plan, they are guaranteed the right to switch back to Original Medicare, which is Medicare Part A (Hospital insurance) and Part B (Medical insurance). However, they are not guaranteed the right to get a Medigap plan unless they are in a special enrollment period (SEP) that allows them to do so.

For example, if someone had an MA plan for the first time and they have had it for less than one year, they would be in a SEP, and they could still get a Medigap plan. Otherwise, they would have to answer health questions, be medically underwritten, and they could be turned down for certain types of health conditions.

NOTE: Medicare Part A and Part B cover approximately 80% of medical and hospital costs, so most people will get a Medigap plan to pick up most of the remaining 20% of the costs that are not covered by Medicare.

Most States Don’t Have a Birthday Rule

Most states don’t have a birthday rule, so the California Birthday Rule is definitely very beneficial for California residents because if your health should change, or if your rates go up significantly, or if you are not happy with your plan or insurance carrier, etc., you can always change to a different plan or insurance carrier, REGARDLESS OF YOUR HEALTH, every year around your birthday. In contrast, for those living in a state without a birthday rule, you could be stuck with your current Medigap plan, insurance carrier, high monthly premium, etc.

NOTE: Some states have recently added their own version of a birthday rule such as Idaho, Illinois, Louisiana, Maryland, Nevada, and Oregon. Besides the birthday rule, other states offer guaranteed issue protections for changing Medigap plans including Connecticut, Maine, Massachusetts, Missouri, New York, Rhode Island, and Washington. Each of these states have their own rules and requirements for changing Medigap plans, which are beyond the scope of this article.

When is the Best Time to Apply For New Coverage Under the California Birthday Rule?

In California, Medigap rates are based primarily on your age and zip code. Other factors that can affect the rate is if you use tobacco products and whether you live alone or with someone else in the household. Under the California Birthday Rule, most insurance carriers base their rates on your age after your birthday, but a couple carriers base their rates on your age on the date your application is submitted and signed. This one year age difference can make a big difference in the rate so for this reason, I normally recommend checking Medigap rates during the 30 days before your birthday each year.

Under the birthday rule, the new effective date is usually the 1st of the month following your birthday. For example, if your birthday is June 3rd, the new effective date would normally be July 1st, etc.

IMPORTANT: I shop around for my clients every year around their birthday to take advantage of the California Birthday Rule. If you aren’t a client of mine, and you would like for me to shop for you too, please let me know. As an independent agent, I work with all the major insurance carriers, and there’s no charge for my service!

10 Standardized Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from with lettered names, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Plan F, Plan G, Plan N, etc. are exactly the same no matter what carrier you are with. In other words, Plan G with Anthem Blue Cross is exactly the same as Plan G with Blue Shield of California, etc. Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

As of January 1st, 2020, Medigap plans purchased by individuals who are turning 65 or who are new to Medicare can no longer cover the Part B deductible, which is currently $240 in 2024. (That amount can change from year to year.) Because of this, Plan C and Plan F aren’t available to people who are new to Medicare on or after January 1st, 2020.

NOTE: If you turned 65 before January 1st 2020 or you were eligible for Medicare before then, you can still get Plan F and Plan C. Those plans just aren’t available for those individuals who turned 65 after January 1st, 2020, etc.

Medigap Plans Are Standardized but Medigap Premiums Are Not Standardized

Although the coverage and benefits for all Medigap plans are standardized, the premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to another for the same identical plan and coverage.

For example, for a 72 year old female living in Encinitas, CA in the 92024 zip code, Plan G rates currently range from $178 to $280 per month for the same exact plan and coverage! That’s a difference of $102 per month or $1,224 per year! Since the monthly premiums vary significantly between insurance carriers, it’s important to shop around periodically.

The Application Process

Today, almost all Medigap insurance carriers in California use online applications that the agent completes. I work with clients throughout California and in several different states, so it’s not necessary to meet in person. The application process is simple, and it usually takes less than 15 minutes to complete.

In addition to the application, under the California Birthday Rule, most insurance carriers require some kind of proof that you currently have a Medigap plan. A copy of your Medicare Supplement card or a recent bill showing which plan you currently have (Plan G, etc.) is sufficient. Once the application has been submitted, the entire application process normally takes a couple of days to a week to complete since there is no medical underwriting. Underwritten applications usually take longer. After you are approved, you should contact your current Medigap insurance carrier to let them know that you will be canceling your old policy when your new policy begins.

CAUTION – Some Insurance Carriers Are Better Than Others!

In addition to finding an insurance carrier with competitive rates, you also have to be careful to choose a good insurance carrier because not all carriers are the same. Although the coverage and benefits for Medicare Supplement plans are standardized and the same, not all insurance carriers are the same; some are better than others!

For example, some insurance carriers will give you a 12-month rate lock and some don’t. Some have better financial ratings than others. Some will give you up to a 12% household discount if you live with someone else in your household, and some don’t. Some have much better customer service than others. Some have call centers in the US and some are overseas. Some provide free gym memberships and some don’t, etc. Price is important, but there are also other factors to consider when choosing a Medigap plan.

For More Information

As an independent insurance agent, I work with the major insurance carriers in California, Nevada, Arizona, and Washington state. I’m not limited to one particular insurance carrier. I shop around for my clients, every year, to find them the best rates, and I’m happy to shop for you too!

If you have any questions about the California Birthday Rule, etc. or if you would like a free, no-obligation Medicare Supplement quote, please don’t hesitate to let me know. There is no charge for my services as I am compensated by the insurance carriers, not my clients!

My contact information is below, and please click here to check out what my clients have to say about me. If you feel that the information in this blog would be helpful to a friend or family member, please feel free to pass it on and please feel free to add your comments below!

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

If You’re Losing Your Scripps Medicare Advantage Coverage… Don’t Panic!

Scripps Will No Longer Accept Medicare Advantage HMO Plans In 2024

Scripps recently began notifying about 32,000 Medicare beneficiaries that beginning on January 1st, 2024, the Scripps Clinic and Scripps Coastal medical groups will no longer accept Medicare Advantage (MA) HMO plans from carriers such as Anthem Blue Cross, Blue Shield of California, Health Net, UnitedHealthcare (UHc), etc. However, doctors from Scripps Clinic and Scripps Coastal will continue to accept Original Medicare Part A (Hospital insurance) and Part B (Medical insurance) as well as Medicare Supplement insurance, aka Medigap.

NOTE: Although Scripps will no longer accept MA HMO plans, I called and asked if they will accept MA PPO plans. I was told that individuals with MA PPO plans can still go to Scripps and see their doctors with those plans, BUT they will be billed as “out of network” instead of “in network” meaning that those individuals could have very high out-of-pocket costs if they continue going to Scripps with MA PPO plans.

If you have to pay out-of-network costs for your MA PPO plan, they are very expensive. In the 92024 zip code, there are 66 MA plans offered in 2024. Of those plans, 56 are HMO’s, and 10 are PPO’s, which are shown below. As you can see, the in-network and out-of-network costs are very expensive for all of the MA PPO plans.

In and Out of Network Costs for 2024 MA PPO Plans Offered In the 92024 (Encinitas) Zip Code:

AARP Medicare Advantage from UHC CA-0035 (PPO)
$9,550 In and Out-of-network
$4,500 In-network

Aetna Medicare Choice Plan (PPO)
$8,950 In and Out-of-network
$5,500 In-network

Aetna Medicare Core Plan (PPO)
$8,900 In and Out-of-network
$3,900 In-network

Aetna Medicare Eagle Plus Plan (PPO)
$9,500 In and Out-of-network
$6,700 In-network

Alignment Health AVA (PPO)
$8,950 In and Out-of-network
$3,900 In-network

Blue Shield Select (PPO)
$8,950 In and Out-of-network
$4,200 In-network

Humana USAA Honor (PPO)
$9,550 In and Out-of-network
$5,900 In-network

Humana USAA Honor with Rx (PPO)
$9,050 In and Out-of-network
$6,100 In-network

HumanaChoice H5525-076 (PPO)
$7,000 In and Out-of-network
$3,900 In-network

HumanaChoice H5525-077 (PPO)
$8,900 In and Out-of-network
$5,900 In-network

If you get seriously sick with one of these MA PPO plans, you can still end up with very high out-of-pocket costs, even if you stay in-network!

The Problem

More than half of the nation’s seniors have MA plans, but many hospitals and care facilities throughout the country are dropping MA plans altogether. Some of the most common reasons are because of excessive prior authorization denial rates and slow payments from insurers. Also, some MA insurers have faced allegations of billing fraud from the federal government, and they are being investigated by lawmakers over their high denial rates. Please click here to read “Kaiser Permanente Sued By Federal Government Over Alleged Medicare Fraud.”

According to Chris Van Gorder, president and CEO of Scripps Health, “It’s become a game of delay, deny and not pay. The health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers. If other organizations are experiencing what we are, it’s going to be a short period of time before they start floundering or they get out of Medicare Advantage. I think we will see this trend continue and accelerate unless something changes.” For more information, please click here to read “Hospitals are dropping Medicare Advantage left and right” by Jakob Emerson.

Scripps Health released a statement explaining the reason for their decision. “Scripps has long served seniors and others in our community who are enrolled in Medicare and Medicare Advantage plans. Scripps and health systems across the country are facing unprecedented financial pressures. We are looking at all we do and, when necessary, making difficult decisions to ensure that we can continue to meet the needs of the community we serve. The revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide.”

Understandably, many Scripps’ patients with MA plans are upset and panicking. If they keep their MA plans, they will no longer be able to keep the the same doctors and specialists they have been going to at Scripps, and they will have to go somewhere else and find new doctors. For those who are undergoing serious procedures such as cancer treatment, etc., this is not a viable option.

Scripps’ Patients Have Three Choices

If you are a Scripps patient with an MA plan, you have three choices for 2024:

  • You can keep your MA HMO plan (or switch to a different MA HMO plan), but if you do, you will not be able to go to Scripps Clinic or Scripps Coastal in 2024, and you must find new doctors.
  • You can keep your MA PPO plan (or switch from a MA HMO to a MA PPO plan, and continue going to Scripps and seeing your regular doctors, but you will incur very high out-of-pocket in-network and out-of-network costs.
  • The third and best option, in my opinion, is to switch back to Original Medicare (Part A and Part B) and get a Medicare Supplement plan.

With the third option, you can continue going to Scripps in 2024 and you can still go to the same doctors, specialists, etc. that you have been going to in the past. For those who are undergoing any serious medical procedures, such as cancer treatment, etc., you will continue in January 2024 with no changes or interruption in service or treatment.

When To Make These Changes

The time to make any of these changes is during the upcoming Annual Enrollment Period (AEP), which begins on October 15th and ends on December 7th every year.

If you want to keep your current MA plan, you don’t have to do anything (as long as it is still being offered in 2024). If you have an MA plan and want to switch to a different MA plan, you must do so during the AEP. You can also apply for or change your Prescription Drug Plan (PDP) or switch back to Original Medicare (Part A and Part B) during the AEP.

NOTE: If you have a Medicare Supplement, the AEP does NOT apply to you unless you want to enroll in or change your PDP. You can change your Medicare Supplement any time of the year.

The Solution

If you would like to continue seeing your doctors at Scripps in 2024, your only option is to drop your MA plan, switch back to Original Medicare, and get a Medicare Supplement. Normally, when you switch from an MA plan to a Medicare Supplement, you must answer health questions and go through medical underwriting. If you have a serious health condition such as cancer, etc., you will not be approved for coverage.

And Now For The Good News!

For all Scripps’ patients that have any kind of a Medicare Advantage plan (HMO or PPO), you can get a Medicare Supplement beginning on 1/1/24 to replace your MA plan REGARDLESS OF YOUR HEALTH! Because of this current situation with Scripps, you will be in a “Guaranteed Issue” situation meaning that you can get the best Medicare Supplement plan available, Plan G, without answering any health questions or being medically underwritten! As a Guaranteed Issue, YOU CANNOT BE TURNED DOWN FOR COVERAGE!

NOTE: With a Plan G Medicare Supplement, your only out-of-pocket cost for the entire calendar year is the Medicare Part B deductible, which will be $240 for all of 2024!

For example, with a Plan G Medicare Supplement, if you have multiple doctor visits, a couple of surgeries, and a hospital confinement in 2024, all you would pay is the $240 Part B deductible and that’s all! That’s a lot better and cheaper than the in-network and out-of-network maximums with MA plans!

Plus, with a Medicare Supplement, you can go to any doctor, specialist, care facility, hospital, etc. ANYWHERE in the US as long as they accept Medicare, and most do, about 93%. If you want to see a specialist, you can go directly to any specialist you want, anywhere in the country. With an MA plan, you must go to your primary care doctor first and get permission to see a specialist that’s in your local network, etc. You have much more freedom of choice with a Medicare Supplement than you do with an MA plan.

Other Guaranteed Issue Situations

There are other Guaranteed Issue situations that will qualify anyone with an MA plan to be able to bypass underwriting and get a Medicare Supplement as a guaranteed issue, REGARDLESS OF THEIR HEALTH. Regardless of your situation with Scripps, everyone with an MA plan should have received their Annual Notice of Change (ANOC) by now. The ANOC is a notice you receive from your Medicare Advantage or Prescription Drug Plan (PDP) every year in late September. The ANOC provides a summary of any changes in the plan’s costs and coverage that will take effect on January 1st of the following year.

If your MA plan did any of the following, you are in a guaranteed issue situation, which will allow you to get a Medicare Supplement, regardless of your health:

  • If your MA plan increased your premium or co-payments by 15% or more from this year to next year.
  • If your MA plan reduced any of your benefits next year from what they are this year.
  • If your MA plan terminated its relationship with your medical provider or the certification of the organization or plan has been terminated, such as Scripps.

Are Medicare Supplement Plans Expensive?

Many people are under the incorrect impression that Medicare Supplement plans are very expensive. I guess that’s kind of a relative question. In California, rates are based primarily on age and zip code, and rates normally go up as we get older.

Nationwide, there are 10 standardized Medicare Supplement plans to choose from, Plan A through Plan N. The term “standardized” means that coverage and benefits for every Plan G, Plan N, etc. are exactly the same, regardless of what insurance carrier you are with. In other words, Plan G is Plan G, Plan N is Plan N, etc. Although these plans and coverage are standardized (exactly the same), the rates are not standardized and prices vary significantly from one insurance carrier to another. For example, in the 92024 zip code (Encinitas), the Plan G rate for a 70 year old ranges from $158.29 per month with Cigna up to $262.04 per month with Humana!

As mentioned before, Plan G is the best Medicare Supplement plan offered today because your only out-of-pocket cost for the entire year is the Medicare Part B deductible, which will be $240 in 2024. As an independent agent, I work with all the major insurance carriers, and I shop around for my clients, every year, to find them the best rates as well as the best insurance carriers.

Do You Want to Change Your MA Plan to a Medicare Supplement Plan?

If you would like to switch from your MA plan to a Medicare Supplement in 2024, I can help you! Please call, text, or email me. My contact information is below. Please send me your birth date, zip code, and whether you live alone or if you have lived with someone else for longer than a year, and I can let you know what the best Medicare Supplement rates are for your age and zip code.

NOTE: Some carriers will give you a household discount (HHD), up to 12%, just for living with someone, even if they don’t have a plan. If this applies to you, please let me know their exact age.

If you’d like to apply for a Medicare Supplement, I can handle everything for you, and there is no charge for my service. If you have any questions or would like a no-obligation quote, please don’t hesitate to let me know.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Choosing the Best Medicare Supplement Plan

If you are turning 65 or you are new to Medicare, it can be very confusing trying to figure out which Medicare Supplement plan (aka Medigap plan) is right for you. The purpose of this article is to answer your questions and to make the Medicare transition easier for you and a lot less stressful!

10 Standardized Medicare Supplement Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Medigap plan are identical regardless of what carrier you sign up with. For example, Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

Medigap Plans Are Standardized But Premiums Are Not Standardized

While the coverage and benefits for each of these plans are standardized, the monthly premiums are not standardized, and prices vary significantly between insurance carriers for the same identical plan and coverage. Other factors can affect the premiums such as your age, zip code, marital status, whether you use tobacco products, etc.

For example, in the 92024 zip code (Encinitas, CA), the Plan G rates for a 70 year old female range from $152 per month to $262 per month, which is a difference of $110 per month or $1,320 per year for the same identical plan and coverage! In California, rates usually go up every year as we get older. For this reason, it’s important to shop around every year to make sure you aren’t paying more than you should be! I periodically stay in touch with my clients, and I shop around for them every year around their birthday.

IMPORTANT: As an independent insurance agent, I work with the major insurance carriers, not one particular company. If you or someone you know has a Medigap plan, I’m happy to shop around for you, and there is no charge for my service!

The California Birthday Rule

In California, we have a law called the California Birthday Rule. This law applies to all California residents who already have a Medigap policy.

Under the birthday rule, you have an annual 90-day open enrollment period that begins 30 days before your birthday and ends 60 days after your birthday. During this period, you can switch to any other Medigap policy that has “equal or fewer” benefits.

For example, if you have Plan G with Carrier A, you can switch to Plan G with Carrier B, regardless of your health and without answering any health questions. There is no medical underwriting and you cannot be turned down for coverage! If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G.

If you have Plan N, you can switch to Plan N with another carrier, but you cannot switch to Plan G because Plan G has more benefits than Plan N, etc.

NOTE: You can change your Medigap plan any time of the year, but if you do so outside of your 90-day annual open enrollment period under the California Birthday Rule, you will have to answer health questions and be medically underwritten, and you can be turned down for certain health conditions.

The Three Best Medicare Supplement Plans

Although there are 10 standardized Medigap plans to choose from, Plan F, Plan G, and Plan N are the three best and most popular plans.

As you can see from the chart, Plan F provides the most comprehensive coverage. Plan G is identical to Plan F except it does not cover the Medicare Part B deductible. Plan N also does not cover the Part B deductible and there are co-payments for doctor visits, emergency room visits, and it does not cover Part B excess charges. Please continue reading for more detailed information.

Plan G Medicare Supplement

For those who are turning 65 on or after January 1st, 2020, Plan G is the best plan today because your only out-of-pocket (OOP) expense is the Medicare Part B deductible, which is currently $226 for all of 2023.

NOTE: That small deductible can change from year to year, but historically, it hasn’t changed significantly. In fact, the Part B deductible decreased from $233 in 2022 to $226 in 2023.

The Part B deductible zeros out every January and starts all over again. Once you meet that small annual deductible, you won’t have any other OOP costs for the remainder of the calendar for any Medicare-approved doctors visits, surgeries, hospitalizations, etc.

Plan F Medicare Supplement

Prior to January 1st, 2020, Plan F was considered to be the best Medicare Supplement plan because there were no deductibles, co-payments, or OOP costs. The only difference between Plan F and Plan G is the Medicare Part B deductible. Plan F pays for that small deductible, and Plan G doesn’t. That is the only difference between the two plans!

NOTE: For those individuals that had Plan F prior to January 1st, 2020, they can still keep their plan and switch to Plan F with other insurance carriers if they want, but Plan F isn’t available for individuals who started Medicare on or after January 1st 2020 because of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Although Plan F covers the Medicare Part B deductible and Plan G doesn’t, the premiums for Plan F are significantly more than the premiums for Plan G, which is why most people with Plan F have switched to Plan G.

Most People With Plan F Have Switched to Plan G

Most people who had Plan F have switched to Plan G because in most cases, the premiums for Plan G are significantly less, and even if you have to pay the $226 Part B deductible, you still end up saving money by switching to Plan G!

For example, if someone has Plan F and their premium is $250 per month and they can get Plan G for $180 per month, that’s a gross savings of $70 per month or $840 per year! If you subtract the $226 Medicare Part B deductible, that’s still a net savings of $614 per year!

NOTE: If you have Plan F and you want to switch to Plan G, if you have already met your $226 Medicare Part B deductible for this year, you would not have to pay it again until the following year since the Part B deductible is payable only one time per calendar year.

Medicare Supplement Plan N

Plan N isn’t as popular as Plan G because there are more OOP costs, but the premiums are usually a little lower, but not significantly lower than the Plan G premiums. If you are in relatively good health and rarely go to the doctor, you may want to consider Plan N if you want lower monthly premiums and you are willing to incur more OOP costs. However, Plan G is a better option if you’re willing to pay slightly higher premiums for much better coverage than Plan N.

NOTE: If you are not in the best of health and you go to the doctor often, Plan N is not a good choice as you are required to pay co-payments for every office visit, and with all those payments, Plan G would normally be more cost effective.

With Plan N, you are responsible for paying the annual $226 Medicare Part B deductible (like you are with Plan G). You must also pay co-payments of up to $20 per doctor visit and co-payments of up to $50 for emergency room visits. However, if you are admitted to the hospital, the emergency room co-payment is waived.

Another difference between Plan N and Plan G is that Plan G covers the Medicare Part B “excess charges” and Plan N doesn’t. If your doctor doesn’t accept “Assignment” (the amount Medicare agrees to pay for a service), they may charge you up to an additional 15% of the bill. This fee is known as an excess charge.

Between Plan N and Plan G, I would recommend Plan G if the premiums aren’t significantly different and it’s not a financial burden to pay the Plan G premiums.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California.

As an independent agent, I work with the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday to find them the best Medigap rates. Please click here to see some of my client testimonials.

If you have any questions, please don’t hesitate to contact me. If you have any friends that are turning 65 or that have Medicare Supplements, I’m happy to shop around for them, and there is no charge for my service!!! Also, please feel free to forward this blog on to anyone who may be interested!

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Medicare Prescription Drug Plans

When Is the Best Time To Sign Up For a Medicare Prescription Drug Plan?

If you are eligible for Medicare, you can generally sign up for Medicare Part D, also known as a Medicare Prescription Drug Plan (PDP) during the Initial Enrollment Period (IEP), which is the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

In addition, you can also sign up for a Medicare PDP during the Annual Enrollment Period (AEP), which runs from October 15th through December 7th each year. During this period, you can join, switch, or drop your Medicare PDP.

NOTE: The AEP is the annual open enrollment period to change prescription drug plans and Medicare Advantage plans, not Medicare Supplement plans. If you have a Medicare Supplement, you can change it any time of the year. If you change your Medicare PDP or your Medicare Advantage plan during the AEP, the new coverage will begin on January 1st of the following year.

If you don’t enroll in a Medicare PDP during your IEP or when you first become eligible for Medicare, you may be subject to a late enrollment penalty if you later decide to enroll in a plan.

What Happens If I Don’t Sign Up For a Prescription Drug Plan During the Initial Enrollment Period?

If you miss your IEP to sign up for a Medicare PDP, you generally have to wait until the AEP to sign up for a plan unless you qualify for a Special Enrollment Period (SEP). A SEP is a time outside of the IEP or AEP when you can make changes to your Medicare coverage.

Here are some examples of events that may qualify as a SEP:

  • Moving to a new address: If an individual moves outside of their Medicare Advantage plan’s service area, they may be eligible for a SEP to enroll in a new plan.
  • Losing other health coverage: If an individual loses coverage from an employer, union, or other health plan, they may be eligible for a SEP to enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan.
  • Gaining new health coverage: If an individual gains coverage from an employer, union, or other health plan, they may be eligible for a SEP to disenroll from their Medicare Advantage plan or their Medicare Part D prescription drug plan.
  • Becoming eligible for Medicaid: If an individual becomes eligible for Medicaid, they may be eligible for a SEP to enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan.
  • Moving into or out of a nursing home or long-term care facility: If an individual moves into or out of a nursing home or long-term care facility, they may be eligible for a SEP to enroll in or change their Medicare coverage.

Not all events will qualify an individual for a Medicare SEP, and the rules and timelines for each SEP can vary. It’s always a good idea to check with Medicare or a licensed insurance agent to confirm eligibility and understand the options available. If you do qualify for a SEP, you have a limited time period to enroll in a Medicare PDP. The length of the SEP varies depending on the reason for the SEP. If you don’t qualify for a SEP, you will have to wait until the next AEP to sign up for a Medicare PDP.

When Do I Need to Sign Up For a Prescription Drug Plan When Coming Off An Employer Health Plan?

If you are coming off an employer health plan that included “creditable” prescription drug coverage and you enroll in a Medicare PDP within 63 days of losing your employer coverage, you generally will not be subject to a late enrollment penalty. Creditable coverage is prescription drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Your employer should notify you each year if your prescription drug coverage is creditable.

If you do not enroll in a Medicare PDP within 63 days of losing your employer coverage, you will be subject to a late enrollment penalty if you later decide to enroll in a plan. The penalty would be calculated based on the number of full months you were eligible for a Medicare PDP but did not have creditable prescription drug coverage.

Important: If you enroll in a Medicare Prescription Drug Plan after the 63-day period, you may also have a gap in coverage, which could result in higher out-of-pocket costs for your prescription medications.

What Is the Medicare Prescription Drug Plan Late Enrollment Penalty?

The Medicare PDP late enrollment penalty is a fee that may be imposed on individuals who enroll in a Medicare PDP after their IEP has ended, and who do not have creditable prescription drug coverage from another source (such as an employer).

The penalty is calculated based on the number of months that an individual went without creditable coverage, and is added to the monthly premium for the Medicare PDP. The penalty amount may increase each year, and the penalty is paid for as long as the individual is enrolled in a Medicare PDP. There are some exceptions to the penalty, such as if an individual had a valid reason for delaying enrollment, such as being covered under a spouse’s health insurance plan, etc.

How To Calculate the Medicare Prescription Drug Plan Late Enrollment Penalty

The Medicare PDP late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2023) by the number of full, uncovered months that an individual did not have creditable prescription drug coverage.

The national base beneficiary premium is the average monthly premium for a Medicare prescription drug plan in the United States, as determined by the Centers for Medicare & Medicaid Services (CMS). The amount of the penalty may increase each year, as the national base beneficiary premium changes.

Here’s an example of how to calculate the penalty:

In 2023, the national base beneficiary premium is $32.74. If an individual goes without creditable prescription drug coverage for 12 months (a full year) after their IEP has ended, the penalty would be 1% of $32.74, or approximately $0.33 per month. Therefore, the penalty amount would be $3.96 ($0.33 x 12 months = $3.96), and this amount would be added to the individual’s monthly premium for their Medicare PDP.

If an individual goes without creditable prescription drug coverage for a shorter period of time, the penalty amount would be lower, based on the number of full, uncovered months, etc. The late enrollment penalty is added to your monthly premium for as long as you have Medicare PDP coverage.

NOTE: The penalty is permanent and may increase each year based on changes to the national base beneficiary premium.

To avoid the late enrollment penalty, it’s important to enroll in a Medicare PDP during your IEP, or when you first become eligible for Medicare, or within 63 days of coming off of an employer health plan, even if you don’t currently take any prescription medications. In California, you can get a Medicare PDP for as low as $4.50 per month!

How Do I Know If I Have to Pay a Penalty?

After you join a Medicare PDP, the plan will tell you if you have to pay a penalty and what your premium will be. In general, you’ll have to pay this penalty for as long as you have a Medicare drug plan.

What If I Don’t Agree With the Late Enrollment Penalty?

You may be able to ask for a “reconsideration.” Your drug plan will send information about how to request a reconsideration. Complete the form, and return it to the address or fax the number listed on the form. You must do this within 60 days from the date on the letter telling you that you have to pay a late enrollment penalty. Also send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.

Do I Have to Pay the Penalty Even If I Don’t Agree With It?

By law, the late enrollment penalty is part of the premium, so you must pay the penalty with the premium. You must also pay the penalty even if you’ve asked for a reconsideration. Medicare PDP’s can dis-enroll members who don’t pay their premiums, including the late enrollment penalty portion of the premium.

How Soon Will I Get a Reconsideration Decision?

In general, Medicare makes reconsideration decisions within 90 days. They will try to make a decision as quickly as possible. However, you may request an extension. Medicare may sometimes take an additional 14 days to resolve your case.

If Medicare decides that all or part of your late enrollment penalty is wrong, Medicare will send you and your drug plan a letter explaining its decision. Your Medicare PDP will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you’ll get a refund. If Medicare decides that your late enrollment penalty is correct, Medicare will send you a letter explaining the decision, and you must pay the penalty.

To Make a Long Story Short…

To avoid the Medicare late enrollment penalty…

  • When you are turning 65, the best time to sign up for a Medicare PDP is during the 7-month IEP.
  • If you or your spouse is coming off of a creditable employer health plan, the best time to sign up for a Medicare PDP is during the 63 days after your employer coverage ends.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to contact me! Also, please feel free to forward this blog on to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

How to Sign Up for Original Medicare (Part A and Part B)

Signing up for Medicare can seem like a confusing and daunting task, but it’s really not that bad. This article will hopefully answer any questions you have and make the Medicare maze easy to navigate.

What is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Who is Eligible For Medicare?

You are generally eligible for Medicare if you are 65 or older, a U.S. citizen or permanent legal resident, and have lived in the U.S. for at least five year

What Are the Four Parts of Medicare?

Medicare is composed of four parts:

  • Part A (Hospital insurance)
  • Part B (Medical insurance)
  • Part C (Medicare Advantage plans)
  • Part D (Prescription drug plans)

NOTE: Medicare Parts A and B are also referred to as “Original Medicare.”

What Does Medicare Part A Cover?

Part A covers things like inpatient hospital stays, home health care and some skilled nursing facility care.

What Does Medicare Part B Cover?

Part B covers things like doctor visits, outpatient services, X-rays and lab tests, and preventive screenings.

What Does Medicare Part C Cover?

Part C is also known as Medicare Advantage (MA). An MA plan is a Medicare-approved plan from a private company that offers an alternative (replacement) to Original Medicare (see note below) for your health and drug coverage. These “bundled” plans include Part A, Part B, and often Part D. In most cases, you must only use doctors who are in the plan’s network. Most MA plans are HMO’s and are restrictive and limit your options to what doctors, specialist, hospitals, and care facilities you can go to.

IMPORTANT: A much better option to Part C, in my opinion, is a Medicare Supplement plan, also known as “Medigap” because it picks up the gap in coverage not covered by Medicare. With a Medigap plan, there are NO networks, and you have much greater freedom of choice as to which doctors, specialists, care facilities, etc. that you go to. You can go to any doctor, specialist, care facility, etc. ANYWHERE in the US as long as they accept Medicare, and most do, about 93%.

What Does Medicare Part D Cover?

Part D covers the cost of prescription drugs (including many recommended shots or vaccines).

The Medicare Initial Enrollment Period (IEP)

If you are turning 65 and are eligible for Medicare, you can sign up for Original Medicare, aka Medicare Part A (Hospital insurance) and Part B (Medical insurance) during your Initial Enrollment Period (IEP), which typically starts three months before the month of your 65th birthday and ends three months after your birth month. For example, if your birthday is June 23rd, your IEP would begin on March 1st and end on September 30th of that year.

NOTE: Medicare normally begins on the 1st of the month of your 65th birthday. If you want your coverage to start then, you need to sign up for Medicare during the 3 months before the month of your birthday. Otherwise, your Medicare won’t start until sometime after your birthday month.

For most people, their Medicare normally begins on the 1st of the month of their 65th birthday. However, if your birthday is on the 1st of the month, your Medicare would begin on the 1st of the previous month. For example, if your birthday is June 1st, your Medicare would normally begin on May 1st.

NOTE: If your birthday is on the 1st of the month, your IEP begins and ends one month earlier as well. For example, if you turn 65 on June 1st, your IEP would begin on February 1st and end on August 31st.

Some People Are Automatically Enrolled in Medicare When They Turn 65 and Some Are Not

If you are currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will normally be automatically enrolled in Medicare, and you’ll receive your Medicare card in the mail before your 65th birthday. You’ll still have an IEP, and during this seven-month window, you can still make Medicare coverage decisions such as signing up for a Medicare Supplement and a Prescription Drug Plan (PDP).

IMPORTANT: If you are not currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you’ll have to sign up for Medicare on your own. If that’s the case, be sure to write down your IEP dates on your calendar before you turn 65.

Three Ways to Sign Up for Medicare

There are the three different ways to sign up for Medicare:

  • You can apply for Medicare online at the Social Security Administration’s website (https://secure.ssa.gov/iClaim/rib).
  • You can call Social Security toll-free number at 1-800-772-1213 and sign up on the phone.
  • You can visit your local Social Security office.

I know that it doesn’t seem intuitive that you would contact Social Security to sign up for Medicare, but you do! When you apply for Medicare, you will need to provide personal and financial information including your name, Social Security number, birth date, income, etc.

After you apply for Medicare, you will receive a confirmation notice in the mail indicating whether your application has been approved, etc. If you have any questions or concerns about the Medicare enrollment process, you can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).

Do I Need to Enroll in Medicare If I’m Working After Age 65

For most people, Medicare Part A (Hospital insurance) is free because you or your spouse paid Medicare taxes long enough while working, generally at least 10 years. However, Part B (Medical insurance) is not free. There is a monthly premium for Part B, which is currently $164.90 each month for most people (or higher depending on your income).

You’ll pay a higher monthly premium for Part B if your modified adjusted gross income (MAGI), as reported on your IRS tax return from 2 years ago, is more than $97,000 in 2023 if you file an individual tax return or are married and file separately, or $194,000 if you are married and file a joint tax return. Please click here for more detailed information about the Part B premiums. Social Security will tell you if you have to pay a higher premium because of your income.

NOTE: If you are planning to continue working past age 65, you may be able to delay enrolling in Medicare Part B and avoid paying the Medicare Part B monthly premium. Since Medicare Part A is usually free, most people sign up for it even if they are working.

If you have “creditable” health coverage from your employer or are covered under a spouse’s employer plan, you may qualify for a Special Enrollment Period (SEP), and be able to delay enrolling in Part B without a penalty.

Medicare defines “creditable coverage” as coverage that is at least as good as what Medicare provides.

Here are some situations that will affect when you should begin your Medicare coverage:

  • If an employer has 20 or more employees, you can generally choose to delay Medicare enrollment, drop your employer coverage for Medicare, or have both Medicare and employer coverage.
  • If an employer has fewer than 20 employees, you will generally need to enroll in Medicare during your IEP.
  • If you have health coverage through a spouse’s employer, what you can do will depend on the employer’s rules. You may be able to delay signing up for Medicare or you may need to enroll at age 65.

IMPORTANT: When you are turning 65, if you aren’t sure if your employer plan provides creditable coverage, you should call Social Security to verify. Otherwise, you could end up paying a penalty.

What If I’m Coming Off An Employer Group Plan?

If you qualified to delay Medicare because you had creditable coverage from an employer, there is an 8-month Special Enrollment Period (SEP) for enrolling in Medicare Parts A and B.

IMPORTANT: Be careful because this SEP can be tricky. Although you have the entire 8 months to get Medicare Parts A & B, you only get the first 2 months to enroll in Part C or Part D without penalty. If you enroll after the two-month period, you’ll face late enrollment penalties for Part D (regardless of whether you end up with a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage).

What If I Don’t Enroll in Medicare On Time?

If you don’t sign up for Medicare Part A, Part B, or Part D on time, you will pay late enrollment penalties for life so make sure to sign up for Medicare coverage during your IEP unless you have other creditable coverage that’s comparable in value to Medicare, such as from an employer. Please click here for more detailed information.

It’s a good idea to start researching your Medicare options a few months before your 65th birthday to make sure you have enough time to enroll and choose the plan that’s right for you.

Original Medicare Will Not Cover All of Your Costs!

Original Medicare (Part A and Part B) does not cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket (OOP) costs including co-payments, coinsurance, and deductibles. Medicare usually pays approximately 80% of allowable charges for covered services.

The Part A Deductible and Co-payments

If you’re a hospital inpatient, Medicare Part A generally covers your care for a limited time. A deductible or copay generally applies.

NOTE: The Part A deductible isn’t an annual deductible, it’s a “benefit period” deductible meaning there can be multiple Part A benefit periods and deductibles per calendar year. In 2023, the Part A deductible per benefit period is $1,600.

The Part A benefit period begins the day you go into a hospital or skilled nursing facility and ends when you have been out for 60 consecutive days in a row. It’s possible to have multiple benefit periods in a calendar year, and without a Medicare Supplement, you would have to pay the full deductible amount for each benefit period!

Most Medicare Supplements pay for all the Part A deductibles, co-payments, etc. With a Plan G Medicare Supplement, your only out-of-pocket cost for the entire year is the Part B deductible, which is currently $226 in 2023.

In 2023, after you pay the $1,600 Part A deductible for each benefit period, there are no hospital co-payments for the first 60 days, but there are co-payments if you are in a hospital for longer than 61 days. Most Medicare Supplements will cover all of these costs.

The Medicare Part B Deductible

In 2023, the Medicare Part B calendar year deductible is $226. Unlike Part A, the Part B deductible is payable only one time per calendar year.

What is the Maximum Out-of-Pocket Expense Limit Under Original Medicare?

Original Medicare (Part A and Part B) have no out-of-pocket maximum amount.

NOTE: A Plan G Medicare Supplement will pick up ALL Medicare-approved costs over and above the $226 Part B deductible!

10 Standardized Medicare Supplement Plans to Choose From

Nationwide, there are 10 “standardized” Medicare Supplement plans to choose from, Plan A through Plan N. These plans are standardized meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits are exactly the same with every Plan G, Plan N, etc. making it easier to compare “apples with apples,” etc.

Although these plans are standardized, the rates are not standardized, so it is important to shop around and compare because the rates vary significantly between insurance carriers for the same identical plan and coverage.

Since there are co-payments, coinsurance, and deductibles and no out-of-pocket maximum with Original Medicare (Part A and Part B), most people get a Medicare Supplement plan in addition to Original Medicare to pay for most of these costs.

The Plan G Medicare Supplement is the Most Popular and Cost-Effective Plan

Of the 10 standardized Medicare Supplement plans, the three most popular plans are Plan F, Plan G, and Plan N. Of the three plans, Plan G is the best plan and most cost-effective because your only OOP cost for the entire year is the Medicare Part B deductible, which is $226 for all of 2023.

NOTE: The Part B deductible can change from year to year, but historically, it has never increased significantly. Once you meet this small annual deductible, you normally won’t have any other costs for the remainder of the year.

How Much Do Medicare Supplement Plans Cost?

In California, rates are based primarily on age and zip code, so Plan G will cost less for someone who is age 65 rather than age 85. For example, in the San Diego area (zip code 92024), the rates for age 65 range from $100 per month to $203 per month! For age 85 in the same zip code, the rates range from $221 per month to $395 per month!

The California Birthday Rule

In California, you can change your Medicare Supplement plan any time of the year, but you would normally have to be in relatively good health to do so because you will have to answer health questions and be medically underwritten. However, California is one of only a few states with a birthday rule called the California Birthday Rule.

Under this law, if you currently have a Medicare Supplement, you can apply for a new Medicare Supplement with “equal or fewer” benefits during the 60 days following your birthday each year, and you cannot be turned down for coverage. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, REGARDLESS OF YOUR HEALTH and without answering any health questions on the application.

NOTE: Only six states currently have a Medicare Supplement birthday rule including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states had a birthday rule.

It’s Important to Shop Around and Compare Medicare Supplement Rates Every Year!

Since there is such a large discrepancy in pricing and because Medicare Supplement rates are constantly changing as we get older, it’s important to take advantage of the California Birthday Rule and compare prices and shop around every year or two.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to contact me! Also, please feel free to forward this blog on to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com