Test Driving Medicare Advantage Plans in Santa Clara Valley

Are recent events tempting you to test drive any of the Medicare Advantage plans in Santa Clara valley? It seems more and more doctors are shying away from traditional Medicare (original Medicare Part A and Part B) in Santa Clara valley. There is a buzz about reports that Sutter/ PAMF (Palo Alto Medical Foundation- formerly Camino Medical Group, Sunnyvale Medical Clinic etc.) is limiting access to new Medicare patients on traditional Medicare (read story). And in 2024, Stanford Medicine severed its only contract with Medicare Advantage.

According to the Kaiser Family Foundation, in 2021 42% of Medicare beneficiaries nationally have chose a Medicare Advantage plan over traditional Medicare. This statistic has been growing for years. So if your current physician is contracted with a Medicare Advantage plan…or if you are willing to try one of these plans, in order to gain access to Sutter/PAMF, should you give it a test drive (note: the number of plans is expanding in 2023- see related story)?

Palo Alto Medical Foundation participates in popular Medicare Advantage plans in Santa Clara valley, as well as San Mateo and Santa Cruz counties. Some individuals are doing a test drive, in order to gain access to Sutter/ PAMF. Before you “drive,” first, get independent advice, locally.

Before You Test Drive Medicare Advantage Plans

I would answer you first need a lot of information, including understanding the risks of Medicare Advantage plans. If I were to develop a list of best practices to research the issue, it would begin with finding a competent, local independent agent whom you are comfortable

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with. Make sure you discuss what, if any, trial rights (i.e. guarantees that you can return to traditional medigap coverage) would apply to your situation. Another recommendation is… find a doctor, before you apply to Medicare.

Best Practices for individuals approaching Age 65

Secure your primary care physician well before applying for Medicare
Find a local, experienced Independent Agent, representing lots of insurance companies

Medicare Advantage Trial Period

When you enroll in a Medicare Advantage plan for the first time, you may have Medicare “trial” protections and additional rights under California law, which could allow you to return to traditional Medicare with supplemental (medigap) coverage. However, these rights do not apply in all circumstances and you should seek a consultation from a competent independent agent before enrolling. I cannot emphasize this enough.

How do Independent Agents Get Compensated?

Local Independent agents do not charge fees, using them does not add to the cost of your insurance. In fact, they are only compensated when they help you complete an enrollment application for insurance coverage. Medicare sets the compensation dollar amount and for Medicare Advantage plans, it is the same from insurer to insurer. So there is really no incentive to favor one plan over another. However, not every agent is independent and not every independent agent represents a large number of plans. You need to ask questions.

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When you find one, treasure that relationship, because good agents get booked up quickly through referrals. You are going to need their help over the years because insurance companies have a tendency to bring new plans into the county and close older plans as time goes on.

By local, I mean an agent who is not out of state and not digital (online only). Chances are good that local agents know your county better: They hear and know what’s going on with local doctors and medical groups e.g.Sutter/ PAMF, SCIPPA, PMG. Plus, Medicare Advantage and standalone prescription drug plans are contracted on a county by county basis. New plans are coming and going every year.

Here are my best practice suggestions for choosing a local, independent agent:

Represents at least three Medicare Advantage plans
Represents at least five Medicare Supplement (medigap) plans
Represents at least four standalone Part D prescription drug plans
Lots and lots of client references– ask for them or check YELP or both

Finding a Doctor

When I suggest “Find A Doctor” I am alluding to the recent development of some doctors shying away from traditional Medicare. The Kaiser Family Foundation published an issue brief in 2020 that estimates 1.5% of California doctors have formally opted out of Medicare. While that leaves a healthy 98.5%, the recent Sutter/PAMF reports could be a game-changer.

Even Medicare Advantage (HMO) plans require you to designate a Primary Care Physician on your enrollment application. Bottomline you need to find a doctor.

Here’s my suggestion: Find your doctors(s) before you apply to Medicare and solidify the relationship by making sure you have been seen within the last year or two. According to reports, PAMF is defining “existing patient” to mean someone who has been seen by their doctor within the last three years.

I have additional ideas for individuals working past 65 (read story).

Bottomline, find a doctor and find a competent, local independent agent.

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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

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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. You could also use the United Healthcare Local Agent Finder tool to find someone near you.

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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.”

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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.

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

Must Read for 62 Year-olds: Before You Reach Medicare
1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY users can call 1‑877‑486‑2048.
Our blog article: The Buzz About Plan G and Plan G Extra
https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf (The official U.S. Government Medicare Handbook, 120 pages)
https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf (Centers for Medicare and Medicaid Services 2020, 52 pages) Will help you understand how Medigap policies work
You can also apply for Part A and Part B at ssa.gov/benefits/medicare
Ask your local Medicaid office about Medicare Savings Programs if you need help due to limited income/resources.
https://www.ssa.gov/benefits/medicare/prescriptionhelp/
Still need help? Then get an independent agent- there is no extra cost.

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How To Enroll Quickly Without Talking To An Agent

When you are new to Medicare, some individuals just want to enroll quickly and electronically, and get it over with.

We are announcing this service for the do-it-yourself crowd at CaliforniaEnrollment.com:

http://californiaenrollment.com

No Agents will spam you, call you or email you.

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? Long 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:

IRMAA-B for Medicare Part B
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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More About IRMAA

More About IRMAA: For audiences age 61 to 64

In the last 12 months, I received too many callers, “surprised (or shocked) by IRMAA,” which inspired a previous, introductory (Part 1) article on the topic. Today’s article, “More About IRMAA,” is Part 2, and goes into greater detail, providing resources for further research. We hope it is helpful.

Short Background

Whereas Medicare Part A is free for most people, Part B is not. 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

Your cost to participate in Medicare Part B and Part D is higher if your income exceeds certain thresholds. For 2022, the first IRMAA threshold is triggered when a person files as Single and has income over $91,000 ($182,000 for Married, filing Jointly).

“Your cost to participate in Medicare Part B and Part D is higher if your income exceeds certain thresholds”

More About IRMAA

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

IRMAA-B for Medicare Part B
IRMAA-D for Medicare Part D

How bad can this get? In 2022, the max out (worst case) IRMAA is $578.30 monthly for Part B, and $77.90 for the Part D IRMAA. Consider that this cost “doubles” when a couple enrolls in Medicare A and B, meaning the annual IRMAA cost could be as high as $15,748. For the planners in my audience, the monthly budget breaks down like this:

Monthly Costs for Spouse 1:

Part B Standard premium: $170.10
Part B IRMAA: $578.30
Part D IRMAA: $77.90
Medicare Supplement Plan G: $127.52 (65 year-old in Santa Clara County)
Part D Prescription Drug Plan: $33.37 (national average)

Monthly Costs for Spouse 2:

Same as above, (less a Household discount for the Medicare Supplement policy)

IRMAA Seems Worse in The South Bay

IRMAA impacts 4% of Medicare beneficiaries, according to the Social Security Administration. In practice, we have observed it closer to 40% to 50%: Many individuals residing in the San Jose

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metro area pay more because the threshold is low i.e. $182,000 (Married, filing Jointly) or $91,000 for all other filers.

Compounding the problem, “income” is taken from two (sometimes three) years prior to Medicare, which is often the pinnacle of your career. During this period “income spikes” may occur, due to cashing in of stock options, taking capital gains etc. These show up in your MAGI (line 11), but with foreknowledge (and a little financial engineering), I believe many can reduce the size of IRMAA.

Know and Prepare for IRMAA

In the years leading up to your Medicare application, Individuals should consider contacting a local independent agent experienced in Medicare and bring your CPA/ tax advisor into the conversation. There are a few solid agents willing to discuss your options now, in exchange for an opportunity to represent your supplemental insurance in the future.

Do Not Pay Too Much

Recently, a delightful couple called me from I received a call from Saratoga: the younger spouse is turning 65 in two months, but the older spouse is a senior engineer, and at age 72, not yet ready to retire. The younger spouse was concerned of Medicare penalties if they did not enroll in Part A and Part B. While every situation is unique, her phone call saved the family thousands of dollars by learning how she could delay Medicare, without penalty. Do not pay too much: just to be sure, request a consult at 408-252-7300.

In The Good-To-Know Corner

“Income” is based on MAGI (line 11 of your 1040 Federal Income tax return), plus adjustments for tax-free interest. Fortunately, the IRMAA is not permanent, and SSA recalculates it every year. You may file an appeal in limited circumstances.

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

The potential for an IRMAA should factor into the timing of receiving capital gains and your retirement date, and ultimately your application for Medicare. Key Point: You have greater control of these factors during the three or four years prior to retirement, so talk to your tax advisor and find a local, independent agent early in the process..

Local Is Good – Independent is Better

A local, independent agent can discuss mitigation strategies and options, such as the fine balance of working a few months longer than scheduled, while carefully avoiding late enrollment penalties (Part B and Part D). Due to baby boomer demographics, good agents are much sought after, so start a conversation early, and build that business relationship before you need it.

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408-252-7300

Would you like me to be your independent agent? Call me and let’s have a discussion, to make sure we are a good fit. Request a phone meeting with Marc, at 408-252-7300.

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 gives back to the community by offering free assistance to new Medicare beneficiaries, residing in California: Call (408) 252-7300.

Resources

For greater clarity on “income” and how MAGI is used, see HI 01101.020: https://secure.ssa.gov/poms.nsf/lnx/0601101010#b

Going deeper: Medicare Sliding Scale Income Tables: https://secure.ssa.gov/poms.nsf/lnx/0601101020

Appealing your IRMAA due to a life-changing event: https://www.ssa.gov/OP_Home/handbook/handbook.25/handbook-2507.html

My Medicare Supplement Is Getting More Expensive

I finally understand why my Medicare Supplement is getting more expensive. In the beginning (age 65), most California plans are under $150 per month. Yet, if you do not take action, it will continue to increase and your smiles will turn to frowns as you get older.

A Common Example

My 85 year-old mother switched Medicare Supplement (medigap) insurance companies and saved $75 per month for the same plan! So, why is my Medicare Supplement getting more expensive? In my opinion, the three biggest culprits are below:

3 Biggest Reasons Your Medicare Supplement is getting more expensive

You purchased a medigap plan that is based on an “Attained Age” pricing methodology, rather than a community rated model. Therefore, rates go up as you get older.
Medicare (CMS) annually increases Medicare Part A and Part B deductibles, coinsurance, and copayments. The annual increased copayment responsibility is passed through to your Medicare Supplement (medigap) plan, which of course adjusts rates to offset the higher costs.
General medical inflation.

Excerpt from Medicare’s (CMS) “Guide To Choosing A Medigap Policy”

Medigap Basics- Medigap Pricing Methodology- p 18

Are Medicare Supplements Really All The Same?

Many Medicare Supplement (medigap) plans are excellent, but they are not all the same. So if

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your Medicare Supplement is getting more expensive, research if your policy was filed with the State of California as Attained Age or Community Rated, as depicted above. Rather than do all the research yourself, find a trusted local independent agent who represents many plans. Let the agent do the work, because it costs you nothing.

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In California, premiums are the same whether you buy directly from a company or with an agent’s help. And, thanks to the California birthday rule, it is easy to change Medicare Supplement (medigap) insurance companies during your birthday month, each year. Note: This is a California rule, and is not available in all states.

Don’t Pay too much, request your free insurance agent consultation below, or Phone (408) 252-7300:

Do You Really Need Medigap Insurance?

Do you really need Medigap (Medicare Supplement) Insurance? What is the worst-case financial exposure for those who rely solely on Medicare Part A and Part B? Many Californians are surprised to learn traditional or original Medicare does not have out of pocket limits. Yet, this type of protection is common with employer-sponsored insurance.

“Do Californians really need Medigap (Medicare Supplement) Insurance?”

Before looking closer at your potential financial out of pocket, let’s be clear on the terms we are using: Medigap (Medicare Supplement Insurance) is not Original Medicare; rather it is private insurance that supplements Original Medicare benefits, such as Part A and Part B. OK, let’s continue…

Assuming an average copayment of 20% for Part B expenses, you could face large financial liability, should you experience surgical work for Cancer, Cardiac, Hip, Knee etc. i.e. services that are not uncommon for individuals over 65.

“The short answer is yes, you do need Medigap (Medicare Supplement) insurance. “

Yet, your financial exposure could be far worse: The preceding paragraph made no mention of your copayment responsibility under Medicare Part A, should you experience hospitalization or skilled nursing services.

For example, Medicare grants each beneficiary a specified number of Hospital Days per lifetime.

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Hospital Days also have significant copayments (see example here), paid by you. A Medicare Supplement (Medigap) policy can add 365 additional days to the 60 day lifetime limit. In summary, Medigap is offered by private insurance companies to supplement the Original Medicare program. If you purchase it when turning 65, the cost is relatively inexpensive, sometimes costing less than what the government charges for Part B.

Never pay more than you have to for Medigap. It is wise to use an independent agent to research several plans at once, saving you time. Good to know: You pay the same monthly premium using an independent agent, as you would purchasing directly from the insurer. So why take a chance of paying more?

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