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Accessing Stanford or Sutter with Medicare

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Navigating Medicare with Stanford or Sutter/PAMF

Accessing Stanford or Sutter/Palo Alto Medical Foundation (PAMF) with your Medicare has become progressively more challenging in recent years.  However, it’s not impossible.

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Gone are the days of purchasing a Medicare policy and keeping it forever. The dynamic Medicare market in the Bay Area is fluid and constantly changing e.g. a new major Plan Closure. Utilize the experience and knowledge of a local, independent agent to make informed decisions about your Medicare options. There is no added cost to your policy for this service. Given the ever-changing nature of Medicare, you may need someone in your corner to help you navigate these complexities in the future.

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Choosing Between Medigap and Medicare Advantage

Depending on your objectives, you might find that traditional Medicare combined with a solid Medigap supplemental policy suits your needs best. In other situations, accessing your physicians through a contracted Medicare Advantage plan may be your best option. An independent agent can act as a time-saving advisor to help you understand the pros and cons of either choice.

“Leverage your time and research with the experience and knowledge of a local, independent agent.”

Our specialty is assisting Bay Area residents who prefer original Medicare plus some type of Medigap Supplemental Plan G and wish to retain their specialists at Sutter PAMF and/or Stanford Medicine. Our advice is free of charge—there are no added premiums or fees. If you’d prefer not to speak with an agent, you can also self-enroll at CaliforniaEnrollment.com.

If you’re facing deadlines and need immediate answers, please complete the Contact Request Form at the bottom of this page. A licensed, San Jose-based independent agent will respond within 24 hours to discuss your options under traditional Medicare.

Act Now to Secure Your Medicare Coverage

Understanding and selecting the right Medicare plan can be daunting. Whether you choose to work with an independent agent or self-enroll, taking action now can ensure you have the coverage you need, tailored to your specific medical requirements at top-tier institutions like Stanford and Sutter/PAMF. Schedule your free 15-minute telephone consultation today and take the first step towards seamless Medicare coverage.

Schedule a Consult:  (408) 252-7300

The Changes to Blue Shield Plan G Inspire What You Need to Know

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Blue Shield of California has announced its intention to withdraw Plan G Inspire from its Medicare Supplement Insurance offerings, potentially as soon as January 1, 2025, pending regulatory approval. This move follows their decision to stop accepting new Plan G Inspire applications back in April.

An Unforeseen Change to Plan G Inspire

As an agent, these developments caught me by surprise. Only last December, Blue Shield was actively promoting Plan G Inspire in select counties across the Bay Area and Northern California.  As a side note, Plan G Extra continues to be offered statewide.  The dynamic nature of the Medicare market underscores the importance of staying connected with a knowledgeable local agent.

Why You Need a Medicare-Focused Agent

The Medicare landscape is constantly evolving, and these changes highlight the necessity of having an agent who specializes in Medicare. Working with an independent agent can provide Plan G Inspire Optionsyou with a broader view of your options.  We help you make informed decisions about your healthcare coverage.   As well as keeping abreast of important provider network changes.

The Value of Blue Shield

Blue Shield has been a significant player in providing innovative features for California seniors. However, if you’re now required to transition to a new plan, it may be the perfect opportunity to reassess your options. Consulting with an independent agent can give you a wider perspective on today’s Medicare choices.

We’re Here to Help You transition from Plan G Inspire

Our local agency has assisted many customers with Blue Shield, United Healthcare, Anthem, and HealthNet. We offer intelligent answers to your questions and can help guide you through this transition…even to gain a better understanding Plan G Extra.  Scheduling a short consultation with us is free and can provide you with the clarity you need during this time of change.

Why Contact Us?

Perhaps you’re a Blue Shield of California policyholder and your current agent hasn’t reached out to discuss these developments.  It might be time to connect with a local agent. Using an independent agent doesn’t add any extra cost to your insurance premiums, but it does offer peace of mind and expert guidance.

Schedule Your Free Consultation Today!

Changes in Medicare Supplement Insurance can be overwhelming, but you don’t have to navigate them alone. Reach out to us for personalized assistance and make sure your healthcare coverage meets your needs:  Phone (408) 252-7300

Rewritten to provide clarity on the changing Medicare Supplement Insurance landscape, this article aims to educate Blue Shield of California Medigap members and seniors about the upcoming withdrawal of Plan G Inspire and the importance of consulting with a knowledgeable agent.  Schedule your Phone Meeting with us.  

Medigap Supplemental Plan G FAQs: Your Top Questions Answered

Medigap Supplement Plan G FAQs

Navigating the world of Medigap plans can be overwhelming, especially with 25 Medigap Plan G

Medigap Supplemental Plan G FAQs: Your Top Questions Answered choices in the San Jose – Mountain View region alone. Plus a recent, major Plan Closure.  How does one determine which is the best choice for your situation? To help, we’ve compiled the top 5 questions from residents in Sunnyvale to Hollister.

Are All Plan G Medicare Medigap Plans the Same?

At first glance, all Medigap Plan G policies might appear identical since they are standardized by the federal government. This means the core benefits remain the same regardless of the insurance company you choose. However, there are differences worth noting, particularly in how these plans are priced and the level of customer service provided.

Do Some Medigap Plan G Policies Cover More Doctors Than Others?

Medigap Plan G policies do not typically vary in terms of the doctors they cover. Most Plan G policies are accepted by any doctor or hospital that accepts Medicare. However, it’s always wise to confirm with your preferred healthcare providers that they accept the specific insurance company’s Medigap policy.

Do Some Medigap Plan G Policies Cover More Services Than Others?

In terms of covered services, Medigap Plan G policies are uniform across all providers. They cover the same services, including Medicare Part A coinsurance and hospital costs, Part B coinsurance or copayments, the first three pints of blood for medical procedures, and more. Nevertheless, the difference lies in additional perks or services that some insurance companies might offer, such as fitness programs or discounts on vision care, which can vary.

Understanding Pricing: Community Pricing vs. Attained Age Pricing

According to Medicare.gov, only one of the 25 Medigap Plan G policies in the Santa Clara Valley has adopted Community Pricing, while most others use Attained Age Pricing. Here’s what these terms mean:

  • Community Pricing: The same monthly premium is charged to everyone, regardless of age.
  • Attained Age Pricing: Premiums are based on your current age and will increase as you get older.

Why Do Monthly Premium Costs Range So Widely?

Even though Plan G benefits are standardized for Part A and Part B medical services, the monthly premiums can vary significantly—from $100 to $188 in Santa Clara County. This difference is due to factors like the pricing method, the insurance company’s administrative costs, and additional benefits they may offer. [Read our sister article, The Buzz About Plan G and Plan G Extra, for more insights.]

Our Expertise in the Bay Area

We specialize in guiding Bay Area residents who prefer Original Medicare along with a Medigap Plan G. Particularly those who wish to retain their specialists at Sutter PAMF and Stanford Medicine. Our advisement service involves no additional premium or fees. For those who prefer an online enrollment without direct consultation, visit CaliforniaEnrollment.com.

Why Local Knowledge Matters

“We help you see what matters most between the Plan Gs, and discern what is ‘marketing fluff.’ An independent agent really makes a difference in explaining the nuances of these plans. Local is better.”

Need Immediate Assistance?

if you’re facing deadlines and need answers now, don’t hesitate to schedule a consultation with us. Do not overpay or miss an important deadline.

Schedule a Consult: (408) 252-7300 or schedule a phone meeting via our calendly app.

“We help you see “what matters” most between different Plan Gs, and discern what is ‘marketing fluff.’  An independent agent really makes a difference in explaining the nuances of these plans.  A local agent is better!.”

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Retiring and Making the Switch to Medicare- A Checklist

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Retiring and Making the Switch To Medicare

Are you preparing to retire and leave your employer-sponsored health insurance and make the switch to Medicare? This transition can be daunting, but understanding the steps involved can Retiring and switching to Medicaremake the process smoother. Here’s a comprehensive checklist to guide you through retiring and enrolling in Medicare.

1. Don’t Rush into Medicare Part B

If you are still working and receiving employer-sponsored health insurance, it’s usually not necessary to sign up for Medicare Part B just because you turned 65, especially if you work for a large employer with 20 or more employees. There are exceptions, so it’s crucial to understand your specific situation. For more detailed information, refer to our related article, “Understand What You Are Getting Into.”

2. Keep Employer Plan Disclosures before Retiring

Documents like CMS-L564 and Annual Notice of Creditable Coverage for prescriptions are essential if you’re 65 or older. Discarding these could lead to extra costs after retiring and switching to Medicare. We recommend starting a Medicare Preparedness File where you can keep this article and other crucial documents as part of your checklist. Schedule a free Calendly Meeting if you would like more information.

3. Keep Your Friends Close but your Doctors Closer before Switching to Medicare

You may have experienced difficulty finding a primary care physician in the Bay Area. Have a conversation with your PCP to confirm if they accept new (or existing) patients on traditional Medicare. It’s also prudent to ask if they plan to retire soon. Knowing this early can give you ample time to find a new primary care physician if necessary. This is critical:  If you schedule a free consult, we will send you some great resources.

4. Seek Guidance from an Independent Medicare Agent

Find an independent agent who specializes in Medicare health plans and offers a broad range of options. Their unbiased advice is invaluable as Medicare plans can change over time. An agent can help you develop your transition plan for retiring and making the switch to Medicare Part A and/or Part B, including a bridge plan for a spouse or partner.  Additionally, they can provide independent feedback on Medigap plans and help you navigate through various Plan G options. For more insights, check out our article, “The Buzz About Plan G and Plan G Extra.”

By following these steps can help you achieve a seamless transition from your employer health insurance to Medicare, and avoid unnecessary hassles or anxiety.

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Schedule a Consult:  (408) 252-7300

Applying For Medicare Part A and Part B

Under normal circumstances, you may Apply for Medicare Part A and even Part B (only) at a local SocialApplying for Medicare Part A and Part B  Security Administration office.  Since appointments are limited, consider applying online:

  • You can apply for Part A and Part B at ssa.gov/benefits/medicare and until recently, via telephone appointment:  In some situations, it may still be possible to schedule a telephone appointment:  Phone Social Security at (800) 772-1213‬.
  • Use this link if you already have Part A and intend to Apply for Part B only
  • Link to Social Security’s Video on applying for Medicare through the Social Security website.
  • When should you begin the process of applying to Medicare? Read about important timelines and deadlines in a recent article on this site or phone our office and request a consultation: 408-252-7300.  The ideal age to start understanding and preparing is age 62.
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Did you know, Local, Independent Agents are a free resource and can help you avoid delays and save time applying Medicare Medicare Part A and Part B.  And there is no added cost to your policy!  This saves you valuable time and helps avoid unexpected delays that could cause a missed deadline. Get a free initial consultation today and sign up for our Newsletter to receive periodic “good ideas” on Medicare.

Best Practices: Applying for Medicare Part A and Part B

  • If you are age 61, 62, 63 or 64, here is another must-read article.  It is also helpful for persons working past 65.
  • Find your doctors well before applying for Medicare- See related article.
  • Find a local, experienced Independent Agent, representing lots of insurance companies.

Schedule a Consult:  (408) 252-7300

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Timelines and Deadlines of Medicare Part B

Applying for Medigap Insurance is easy, but understanding the timelines and deadlines of Medicare Part B is critical, and will be the focus of the remainder of this article.  Insurers will not issue you Medigap (Medicare Supplement) Insurance until you are enrolled in Medicare Parts A and Part B. However, many will accept your application early and pend it, while your Medicare application is being processed.

Timelines and deadlines of Medicare Part B

The official U.S. Government Handbook on Medicare is called Medicare and You. Another valuable government publication is Choosing a Medigap Policy.  These combine for 128 pages of valuable information.  Yes, it’s a lot of pages, and if you want the readers digest version, ask for help:  Connect with an independent agent in west San Jose- it’s FREE and will save you hours of time: (408) 252-7300.  The links to publications are at the bottom of this article, and the following are some important excerpts:

Timelines and Deadlines of Medicare Part B:  Initial Enrollment Period

I encourage everyone to get a local consultation e.g. Silicon Valley/Bay Area by age 62, in order to understand “what you are getting into.”  But once you reach your Initial Enrollment Period or IEP, you can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months

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of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in Part A (that you have to pay for) and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed. 

“Remember, in most cases, if you don’t sign up for Part A (if you have to buy it) and Part B when you’re first eligible, you may have to pay a late enrollment penalty.”

Still need help?  Then get an independent agent– Did you know there is no extra cost for these services?  They are compensated by your Medigap insurance company and you will pay the same low premium with or without an agent.

Timelines and Deadlines of Medicare Part B:  General Enrollment Period 

If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1–March 31 each year. If you enroll using this SEP, Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

What’s the Part B Late Enrollment Penalty? 

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up for it. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty. See page 17

Still need help?  Then get an independent agent– there is no extra cost for these services.

In California, many of us work past Age 65, how does that affect timelines and deadlines?

If you didn’t sign up for Part B when you were first eligible because you’re covered under a group health plan based on current employment, then you can sign up for Part B anytime while you’re still covered by a current employer group medical plan.  You also may sign up for Part B during the 8-month period, immediately after employment or coverage ends (the period begins based on whichever occurs first). This is referred to as a Special Enrollment Period.  

If you are working past 65, and thinking about transitioning off employer health insurance,  we have prepared a checklist to help you, but read this first.

There are other Special Enrollment Periods, in certain situations. Get an independent agent to guide you at no extra cost or phone Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227).

Resources and Links

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The Buzz About Plan G and Plan G Extra

Choosing The Best Medigap Plan G

What’s all the Buzz about Plan G and its “medigap cousin,” Plan G Extra?  For persons turning 65 on or after January 1, 2020, Plan G replaces the hugely popular Plan F.  Early feedback is Plan G is just as popular as before, and now, in 2024 there are additional plans to consider,  the appropriately named “Plan G Extra” (or Plan G Plus or Plan G Inspire, which is being withdrawn from Blue Shield’s portfolio) the name varies according to the medicare supplement insurer who issues it).

“Breaking News:  The popular Blue Shield of California Plan G Inspire will be withdrawn from the market for new enrollments, effective 4/1/2024.”  Please use our Calendly app if you wish to schedule a discussion about this plan with one of our licensed agents.

Plan G Extra Benefits

Plan G Extra is a separate plan, distinct from the regular Plan G:  Think of it as constructed on a

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Plan G chassis or base plan, with some added benefits.  So what’s the Buzz About the Plan G “Extra” benefits?  First, the premium difference is minor.  Second, the additional benefits are for services not covered by Medicare, so these are truly “bonus” coverages e.g. Vision, Hearing
Aide, Gym services etc.  Request a Q&A phone session with one of our licensed sales agents, using Calendly.

We are a bay area family-owned insurance agency representing United Healthcare and Blue Shield of California medigap plans for 2024 and 2025.  There is no extra cost to using a local agent.  But if you want to enroll quickly without talking to an agent, go to CaliforniaEnrollment.com.

 

View Blue Shield Comparison of Plan G and Plan G Extra or Inspire

Blue Shield is one of the insurers who offer both Plan G and Plan G Extra (not every insurer offers both plans).  For FAQs on Plan G, including summary of benefits, pricing and required disclosures, phone us at 408-252-7300.  There’s no obligation to buy from this Not-For-Profit, Northern California-based insurer.  Read more about Blue Shield’s Not-For-Profit status and other Blue Shield savings below.

Blue Shield Savings

With Blue Shield, there are several opportunities to save on your monthly plan dues. One example, is the savings due to increased efficiencies from administering Medicare Supplement plans are passed on to the subscriber, not Wall Street.  Blue Shield’s Not-For-Profit status means savings for you!  Continue below to checkout the Buzz about Plan G and Plan G Extra:

Blue Shield Plan G and Plan G Extra plans

Finally, an interesting aspect of the Plan G “extra” plans is the “additional benefits” vary from insurer to insurer. In fact, many insurers do not even offer the “extra” version of Plan G. Research Tip: It costs nothing (“extra”) to hire an independent agent to explain the differences. The premium is the same with or without the agent. Moreover, the insurer compensates the agent for enrolling you.  So chat with an agent today or just self-enroll at CaliforniaEnrollment.com.

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“We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

Leaving Employer Insurance For Medicare

Get Prepared for Part B

It is time to think about leaving your employer insurance for Medicare and to Apply for Medicare Part B.  The purpose of this article is to help you prepare for Medicare, in advance, Leaving Employer Insurance for Medicareand to avoid missing important deadlines, which could lead to missed opportunities or even extra costs.  Bookmark this story or share it with a friend.

CHECKLIST: Leaving Employer Insurance and Transitioning to Medicare From Employer Health Insurance

  1. First, if you are currently working and receiving employer-sponsored health insurance, do not sign up for Medicare Part B solely because you turned 65.  Read our related article to “Understand what you are getting into.“  While there are some exceptions, if you work for a large employer (20 or more employees), you don’t need to do this yet.
  2. Second, those employer plan disclosures e.g. Annual Notice of Creditable Coverage for prescriptions? Don’t throw them away if you are Age 65 or older.  This could cost you extra money.  My advice is to start a Medicare Preparedness File, and save this article as part of your checklist.
  3. Third, have a discussion with your primary care physician:  Ask if they currently accept new patients, especially those on traditional Medicare.  Be bold, and ask if they plan to retire in the near future.  It’s better to find out sooner than later if you need to research a new primary care physician.
  4. Fourth, find an independent agent who focuses on Medicare health plans…and I mean lots of plans e.g FAQs on various Plan Gs.  You are going to need their ongoing, independent advice, as plans (and Medicare) do change over time.  Plus, you need help initially, to discuss a transition plan for leaving employer insurance for Medicare Part A and/or Part B and possibly coordinating temporary COBRA coverage for you and/or a spouse .  Finally, get independent feedback on all the medigap plans and different “flavors of G.”  We put together a good introduction to this topic.  Read:  The Buzz About Plan G and Plan G Extra.

“Our insurance agency is local, and fiercely independent, and contracted with 37 different insurance companies.”

It Is Foolish Not To Use A Local, Independent Agent

Californians do not receive a premium discount when you bypass an agent to go directly to

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the insurer; you only lose your “independence.”  Once you understand this, it is in your best interest to find an experienced, independent agent  to help your transition from employer-sponsored plans to the Medicare world (It’s better than waiting on hold for two hours with Social Security).

A more detailed article on these issues and important timelines and deadlines can be found on our website, derendingerins.com.

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“We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

Before You Reach Medicare

Understand What You Are Signing Up For- Medicare (Before You Do It)

Do not apply for Medicare in the next 3 to 6 years if you are not familiar with the hazards highlighted in this article. What you do (or don’t do) today matters in the future, when you sign up for Medicare.  I feel compelled to share real life experiences to help those in the early planning stages of “life after 65.” This includes people age 61, 62, and persons working and deferring Medicare until age 68, 70 and later. Before you reach Medicare, you should understand what you are signing up for.   This article is dedicated to the many, sad phone callers like this one:

“…I signed up for Medicare 2 months ago, and then applied for Medicare Supplement (medigap) insurance, as well as my Part D prescription drug plan.  I don’t understand why I just received an invoice for $1,482.00 from the Department of Health & Human Services…is this a monthly bill?  Is this my new supplemental insurance?”

The Problem

Individuals go to the Social Security Administration (SSA) to sign up for Medicare Part A & B.  Do you understanding everything you are signing up for?  Before You Reach MedicareLong before you reach Medicare, talk to your CERTIFIED FINANCIAL PLANNER™, as well as a local, independent agent.

“Best Advice:  Talk to your financial advisor and an independent agent when you turn 62.”

Whereas Medicare Part A is free for most people, Part B is not.  Medicare Part B enrollees pay a monthly premium representing about 25% of the Part B estimated program costs.  For 2022, this so-called, Standard premium is $170.10 per month.  The government subsidizes the rest, but…

The Cost is Greater Than You Think

In truth, many individuals residing in the Santa Clara Valley pay more, because the Standard Part B premium is adjusted higher for income:  this increased amount is called “IRMAA.”   My

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observation during the last 12 months:  there is a real problem with SSA failing to educate applicants. Early education and understanding gives you a fair chance to delay Medicare, where possible, to reduce the IRMAA.  No offense intended for the good folks at SSA, but based on the sheer number of phone calls I receive… I think the organization can do better.

Introduction to IRMAA

Best Advice:  Talk to an independent agent and your financial advisor when you turn 62.  If you are working past age 65, initiate contact at least three years before you apply to Medicare or leave your current employer health plan.

IRMAA is the Acronym for Income-Related Monthly Adjustment Amount; there are two versions associated with Medicare:

  1. IRMAA-B for Medicare Part B
  2. IRMAA-D for Medicare Part D

The short introduction is, your cost to participate in Medicare Part B and Part D is higher if your income exceeds a certain threshold.  For 2022, you trigger the first IRMAA threshold at $91,000 (filing Single).  For greater detail, schedule a phone call or read Part 2 of this article.  The balance of this page will keep it simple.

Good-To-Know (Before You Reach Medicare)

Here is a “good-to-know” aspect of IRMAA:  the IRMAA calculation is based on IRS information provided to the Social Security Administration (SSA) from two or three years earlier.  You trigger an IRMAA when your income exceeds certain thresholds.  “Income” is based on your MAGI (line 11 of your 1040 Federal Income tax return), plus adjustments.  Fortunately, the IRMAA is not permanent and SSA recalculates your amount each year.  You may appeal the IRMAA in certain situations.

“The potential for an IRMAA should factor into the timing of receiving capital gains and your retirement date.”

The potential for an IRMAA should factor into the timing of taking capital gains.  Other factors include your retirement date, and ultimately your application for Medicare.  You have greater control of these factors the three or four years prior to retirement, so talk to an independent agent early in the process; definitely include your tax and financial advisors in the discussion.

Before You Reach Medicare

An independent agent can discuss mitigation strategies and options.  Perhaps you could work a few months longer than scheduled, while carefully avoiding late enrollment penalties (Part B and Part D).  Good agents are highly sought after, so start a conversation early, and build that business relationship before you need it.

408-252-7300

Would you like me to be your independent agent?  Call me at 408-252-7300 to discuss if we are a good fit.

Editor’s Note:  Marc Derendinger is an independent agent serving Santa Clara County residents for more than 30 years.  He helped the City of San Jose establish its first-ever group voluntary long-term care plan in 2001, served as an advisor to the State of California DHCS California Partnership for Long-term Care, and currently serves as insurance broker for the San Jose Police Officers’ Association.  Marc offers free assistance to new Medicare beneficiaries residing in California, at (408) 252-7300.

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