Open Enrollment – time is short

As Medicare Annual Open Enrollment Period (October 15- December 7, 2015) is winding down there is still time to choose a new plan, drop a plan or just seek advice regarding any questions you may have. If you decide to keep your plan, you do not need to do anything. It is always a good idea to check other plans each year to make sure there is not a better plan for your needs. Of course, make sure your doctor and medications are covered in your plan.

QualCare is a new independent physician provider group for Medicare Anthem Blue Cross and Health Net plans. It allows for more choices for the beneficiary. You must choose either QualCare providers or you may choose Bakersfield Family Medical Center/Heritage Physician Network. It is exciting to have more choices. For QualCare you would choose a primary care doctor from Omni Family Health here in Tehachapi and then he or she would direct you to the many specialists within QualCare. The same procedure is true for BFMC as both of them serve the HMO’s (Health Maintenance Organization). As many of you know, you must stay within a HMO’s network as the insurance carrier or Medicare will not pay unless it is a true emergency. This is also true for health plans that are HMO’s.

Although Annual Open Enrollment is quickly ending there is a Medicare plan that you may buy at any time of the year. It is called a Medicare Supplement plan here in California and in the rest of the United States it is called a Medigap plan as it helps cover the gap of 20% that Original Medicare (Part A and Part B) do not cover. Remember, from my previous articles, Medicare A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and Home health care. Part B is Medical insurance and helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (wheelchairs, oxygen) and some preventative services.

For the supplement plans, there is a paper booklet entitled Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare included with the Medicare supplement booklet and application for each company and its purpose is to help you decide if a supplement plan is appropriate for you. It covers the type of policies available which are standardized policies. For example, the F plan is the F plan for all companies. The only difference may be what they charge for the plan. It also details what the plans cover, your rights to buy a policy and how to buy the policies. I have several copies of this booklet which I would be glad to give you. The prime time to buy these Supplement policies is within the 6 months of purchasing your Part B plan as your application does not go through underwriting where it could be turned down for coverage.

I have a lovely couple who have Medicare A and Medicare B, a Part D plan for prescription drug coverage and a Medicare F Supplement plan and have been very pleased with the coverage. The Part B, Part D and Supplement plans do have a premium. For the supplement plan the premium is age attained.

There are some wonderful resources for you to use via your computer. One is http://www.Medicare.gov or http://www.Socialsecurity.gov . Each year a Medicare book entitled Medicare & You is printed and should be sent to your home once you are on Medicare. If you don’t receive it, you can request a copy from Medicare via online from the Medicare site mentioned above or phone 1-800-633-4227. For Social Security questions or help you may call 1-800-772-1213. You can even leave a message with your name and a time when you would like to receive a call back.

I wish you a very joyous and happy holiday season filled with lots of wonderful memories.

Sue Wonacott can be reached by cell phone 661-304-4695, email: [email protected], or by dropping by Marty Pay Farmers Insurance Agency, 121 East F Street or by calling the office (661) 822-3737.