Author: Lance

by Lance D. Reedy

Unfortunately, many people still mistakenly believe that they can’t change their Medicare supplement plan after the December 7th AEP deadline. As such, we have updated this article for 2020.

The good news is that you can change your Medsupp plan any month of the year, providing that you medically qualify. If your Medsupp rate increases have been above normal, you may be able to qualify for a lower premium plan.

Yes, you can change your Medicare supplement plan any month of the year as long as you medically quality with the new company.

We work with most of the Medicare supplement companies and can assist you in shopping for lower rates. Please call us first!

Remember, medical qualification applies. More about this shortly.

Another smart move, if possible, is to change your plan letter. For example, if you have an increasingly spendy Plan F with Company X, a good solution is to switch to Plan G. Another good reason to move out of Plan F is that people turning 65 after January 1, 2020 are not able to sign up for Plan F. Note: This does not need to be done right away, but it’s something to think about for the future. As these existing Plan F’s age, they will continue to go up.

How do I qualify for a new Medicare Supplement plan?

To qualify for a new Medsupp plan, in general you will need “No” answers to the following health questions. The language on each companies’ application may vary somewhat, but they are similar.

1) In the last two years have you had or been treated for circulatory or heart disease including a heart attack, heart bypass surgery, stent placement, atrial-fib, or pacemaker implantation?

2) Have you been treated for internal cancer, melanoma, or lymphoma in the last two years? (Does not include most skin cancers.)

3) Have you had a stroke or TIAs in the past two years?

4) Have you been diagnosed or treated for COPD, emphysema, or chronic bronchitis in the past two years?

5) Have you been hospitalized more than two times in the last two years?

6) Have you been diagnosed with any type of dementia, Alzheimer’s, or Parkinson’s disease? Note: One of our companies will take people with these conditions if there are no other major issues.

7) Do you have any auto-immune disease such as AIDs, HIV, multiple sclerosis, rheumatoid arthritis etc? (Other diseases may be included depending on the company.)

8) Do you have any planned procedures like physical therapy or surgeries such as a joint replacement or a cataract surgery recommended to be completed in the next twelve months?

These are the major categories. A company may request additional information.

Routine prescriptions such as blood pressure, cholesterol, and type 2 diabetes meds are usually okay. Most companies have a drug decline list. Examples are opioids and many cancer related drugs. The companies generally require that you list all prescriptions on your application. Certain combinations of drugs such as ones used to treat diabetes (particularly insulin) and hypertension may cause a decline with one or two companies.

Why do we pre-qualify you before applying?

If you have a medical condition that is iffy, we can shop for the company that is most likely to accept your application. One company may be more picky about one particular health issue compared to another. Through the years, we have learned that a certain health issue that may not fly with one company can go through with another. Many companies will decline hydrocodone use, but one or two companies will consider your application.

Why are some people reluctant to change if they can quality for substantially lower rates?

The biggest reason that we have seen is fear. They are afraid that the new company won’t pay its claims. However, this fear is completely unfounded. The plans are standardized, and all companies pay their claims. We have encountered folks who could save $80 per month or more by changing out of an old, expensive plan. Unfortunately, a few of them wouldn’t budge because they were deathly afraid that their new company won’t pay its claims.

Do we ALWAYS shop for the lowest rate available?

Not necessarily. In fact, there are a couple of companies that we avoid. One of them was owned by one hedge fund that pawned it off to another hedge fund. The game they play is to come out with absurdly low rates. People will chase those rates only to discover that within two years or so the rates are going through the roof.

This game is called “buying the business.” A company is willing to break even or even lose money to get a bunch of people signed up. They also entice agents to peddle their product with high commissions and lucrative production bonuses. Within two years or so they go to the state insurance department, show their losses, and file for big rate increases. Meanwhile, If a person has developed an uninsurable condition, he/she is stuck with that company. Sorry, that’s not a game we’re going to play. We prefer to work with reputable companies.

What if I have a health issue that no new company will accept?

The solution for the people in this situation may be switching to a Medicare advantage (MA) plan during the fall October 15 through December 7^th Annual Election Period (AEP), also known as Medicare open enrollment.

There are pros and cons involved in switching to an MA plan. Please contact us for details. On the other hand, many people are happy enough with their current plan. Nothing says that you have to change.

Why is it much easier to switch to a Medicare advantage (MA) plan?

The only health question on an MA application is kidney failure. You could have had a recent stroke, been treated for cancer in the past two years, or have multiple sclerosis, and you still can qualify for an MA plan. Those conditions will likely cause a decline on most any Medsupp company’s application.

However, switching to an MA plan is not feasible for some people if they live in a county that has no available MA plan.

How do I find out if I’m eligible for lower rates? Please call us at (208) 746-6283 or (888) 746-6285, or email us at lance@nwsimail.com. If you have a health situation that you believe may be an issue, contact us anyway, and we’ll see what we can do. End

by Dr. Bruce Fife

Chapter 1: A Big Fat Mistake

Dr. Fife by profession is a certified nutritionist and naturopathic physician, and he authored over 20 books dealing with health and healing. He also is a very strong advocate of using coconut oil in place of vegetable or seed-derived oils.

If I could sum up this chapter with a one-word acronym it would be this:

LCHF, meaning a Low Carbohydrate, High Fat diet. In essence, that’s the gist of Dr. Fife’s book.

Dr. Fife starts the chapter by discussing a patient named Reyn. At 370 pounds, Reyn was a disaster waiting to happen. His cardiologist had him on the usual trifecta of prescription drugs including blood pressure meds, statin drugs, metformin for blood sugar, and Victoza to lose weight.

Reyn followed his doctor’s usual nutritional advice of eating a low-fat diet along with lean protein. This included, of course, avoiding saturated fats. His meals were centered around grains, fruit, and low-fat dairy. Because he took his meds, Reyn felt free to occasionally indulge in sweets, especially if they were sweetened with artificial sweeteners.

Despite taking his meds and following his doctor’s dietary advice, Reyn’s health continued to decline. He was hospitalized due to heart problems and blamed it on bad genetics.

Reyn attended a health conference where he heard about Low Carbohydrate, High Fat (LCHF) diets for the first time. Afterwards, he listened to several speakers extolling the virtues of the LCHF diet. One of them was Jason Fund, MD, a featured speaker at the conference.

The concept of the LCHF diet was new to Reyn, and it was contrary to his pre-conceived beliefs about diets. The following are some attributes of the LCHF diet:

• High carb foods such as grains, starchy vegetables, and most fruits are limited.
• Fat consumption is significantly increased. Non-fat milk is replaced with full-fat milk. Low fat cheese is replaced with full-fat cheese.
• Most of the fats are saturated
• The use of poly-unsaturated vegetable (seed oils) from soybeans, canola, corn safflower, etc. is limited.
• Fatty cuts of meat are fine and preferred over lean meats

Dr. Fife points out the we [as a society] have been eating low fat for over 40 years, and what has it gotten us? Obesity is at an all-time high, and degenerative diseases such as type 2 diabetes, Alzheimer’s, arthritis, fibromyalgia, etc. are at epidemic proportions.

He points out that a growing body of research is showing that LCHF diets….

• Can balance blood sugar
• Improve blood cholesterol levels
• Lower elevated blood pressure
• Melt off excess body fat
• Boost energy levels
• Balance hormones
• Strengthen the heart and much more

Dr. Fife makes this key point:

While medications may help relieve symptoms associated with the above conditions, the LCHF diet can accomplish the same thing and allow their patients to get off their drugs and lead healthier lives.

My Comment: Who wouldn’t that for his/her life?

Continuing: Here’s what Reyn did. He embraced the LCHF diet to the point where 75% of his calories were from fat, 15-20% from protein, and 5% were from carbs.

Here’s what happened. He was able to wean himself off his insulin and cholesterol meds until he stopped them entirely. When Reyn told his cardiologist that he didn’t want to renew his meds, his doctor scoffed at him.

After a year, he lost 117 pounds and ate full meals until he was satisfied. He had more energy than ever, and he discovered weight loss was never so easy. His A1C levels normalized, and his peripheral neuropathy caused by his diabetes vanished completely. A year ago, Reyn left the hospital with one foot in the grave, and now he’s a new man.

Low-Fat Diets Are Killing Us Fife next delves into the problem with the government food recommendations. He specifically takes to task the recommendations to eat more grain of “6-11 servings per day” which could include white bread rolls, muffins, and packaged dry cereals. Fried potatoes, catsup, and pizza sauce could fulfill the vegetable requirements. Sugary fruit juices, cherry pie filling and sugar soaked canned fruits all can satisfy the fruit requirements. Non-fat milk and cheese are to be preferred over the full-fat versions. Lean meats and egg white are preferred, and fats and sugars are to be used sparingly.

Key point: This reduction in fat has led to an increase in carbohydrate consumption because removing fat from meals generally leads to eating more carbohydrate-rich foods to make up for the loss of calories from fat.

My comments: You can bet your last dollar that to make matters even worse, these carb calories are primarily from refined carbohydrates. This list includes pizza crust, white rice, bagels, rolls, and bread. Even most so-called whole wheat breads are mostly made from “enriched” white flour.

All of this contributes to the spiking of your blood sugar level which then can lead to insulin resistance. It is this insulin resistance that opens to door to metabolic syndrome, which consists of obesity, type 2 diabetes, heart disease, and a long list of other maladies.

Continuing: Fife makes another key point:

Although the guidelines suggest limiting sugar intake, this advice is not stressed and has generally been ignored, with more emphasis placed on reducing total fat intake and cutting out saturated fat and cholesterol as much as possible.

Even worse, since saturated fats have been demonized, they have been largely replaced with polyunsaturated vegetable* oils. Included in this group of unhealthy fats are hydrogenated vegetable oils. shortening, and margarine. *Calling these oils vegetable oils is a bad misnomer. With mainly the exception of olives, you don’t get oil from vegetables. Rather, you get the oil by squeezing soybeans, canola (rapeseed) seeds, corn, etc. at very high pressure.

In 1961, the American Heart Association (AHA) recommended a low-fat and low cholesterol diet. In spite of this, as Fife points out, 60 years later heart disease is still the number killer in the USA.

He continues by saying that one of the rationales for the low-fat diet was to help people lose weight. The statistics, unfortunately, say that just the opposite has happened. In 1975 45% of adults were overweight. Now it’s 75%.

Likewise, there has been an accompanying rise is type 2 diabetes rates. He points out that Alzheimer’s disease is now referred to as type 3 diabetes or diabetes of the brain. He comments that the rates of other degenerative diseases are also on the rise and suggests that since those rates continue to climb, the cause is not genetic. He points out that we are now seeing Alzheimer’s occurring at younger and younger ages.

Fife explains that the cause for these increased disease rates is primarily due to the faulty dietary advice.

Key takeaway point:

If you want to lose excess weight as well as reduce your risk of stroke, heart disease, atherosclerosis, cancer, and many other degenerative diseases, you should eat more fat and less sugar and refined carbohydrates…

Dr. Fife points out that fat has been savored by people eating ancestral diets. Fat on game meat was relished. People enjoyed excellent health on high fat diets.

My comment: The Eskimos relish the fat from their game meat and throw the lean meat to the dogs. Maybe there is more to it than just needing the fat to help keep themselves warm in cold climates.

What an LCHF Diet Can Do for You

Fife lists 40 degenerative diseases where the conditions can be stopped or reversed with an LCHF diet. Here are twelve of them.

• Alzheimer’s disease
• Cancer
• Cataracts
• Coronary heart disease
• Diabetes
• Glaucoma
• Hypertension
• Kidney disease and kidney stones
• Macular degeneration
• Parkinson’s disease
• Sleep apnea
• Ulcerative colitis

In addition to improvements in the above conditions, he continues by enumerating the changes that an LCHF diet may bring to your life:

• Get off most, if not all of your medications
• Have more energy
• Be more resistant to infections
• Feel better, sleep better, and have a clearer mind and a better memory
• Experience an overall enhanced feeling of well-being

Dr. fife makes this concluding comment about the LSCH diet:

Not all fats are of equal value, and some can be harmful, or harmful if eaten to excess…This book will be a guide.

While it may look that an LCHF diet can correct just about anything, it is not a cure-all, nor do I claim it to be such. The diet itself doesn’t cure anything. It simply provides the body with the nutrients it needs to correct imbalances caused by poor dietary and lifestyle choice. If you have been eating the standard low-fat diet, this new way of eating has the potential to significantly improve your health. It may just be the solution you are looking for. Give it a try—you have nothing to lose except your poor health.

End

It seems like not a year goes by without some major shakeup regarding either Medicare advantage or Medicare Part D Prescription (PDP) plans. This year we have changes on steroids.

The first headache agents and other senior volunteers will be facing this fall is that the Center for Medicare and Medicaid Services (CMS) is changing its Prescription Drug finder (PDF) on Medicare.gov. For years we have had the ability to create a “Drug List ID.” This gave us a unique ten-digit ID number and the date of our search and the option to save our list. It has been an invaluable tool for us.

Let’s say Betty Rubble takes ten meds. Also, let’s say that last fall during the Annual Election Period (AEP from Oct. 15 through Dec. 7) I pulled up her previous list. Betty told me that she dropped one of her meds and added a new one. I would not have to reenter all of her ten meds. I’d simply recall the saved list by populating the fields for the drug list ID and the date of our original search.

Voila, the list of her ten meds pulls up. we delete the one med she has discontinued and add her new one. We enter her preferred pharmacy and hit “Continue to Plan Results.” The website sorts the PDPs in order of the best buys. By best buy we mean the estimated annual cost.

This estimated annual cost includes and is the sum of the following:

• The monthly premium times 12.
• The deductible if there is one.
• The copay for her meds before and after the deductible.
• Her costs when she is in the coverage gap (if applicable).
• Her catastrophic costs once she has moved out of the coverage gap (if applicable).

There have been a few minor traps that a new user could fall into when using the PDF, but a knowledgeable person knew what they were. In short order we advised our clients which PDP that would be their best buy for the upcoming year. One exception for not chasing the lowest cost plan was a PDP with a sub-standard rating. Another exception has been a company known for poor customer service. Other than that, we’d recommend the plan that was the best buy.

Some plans compensate the agents and others don’t. We’d have recommended to you to the most cost-effective PDP irrespective of whether or not the plan compensates agents. Also, there is no incentive for an agent to “churn” people from one plan to another. CMS does not allow any additional compensation for doing this.

We’re happy to provide this service for our clients and we will continue to do so. However, we’re entering uncharted territory this year because of the changes that CMS has made to the prescription drug finder (PDF) on Medicare.gov.

First, our saved drug list will not carry over to the new PDF. That means the hundreds of saved lists are going POOF! Gone!

Medicare wants you to set up a My Medicare account. You enter your date of birth, your Medicare number and create a username and password. So far, the PDF does not give a simple list of the best to the worst buys. It uses a different format for comparing plans. Our experience is that it sorts by premium or copays. Thus, the user has to enter different sort criteria.

The new PDF may be easier for you the consumer to navigate, but it appears to be far less friendly to agents and senior volunteers that do multiple searches per day. You can spend an evening to get set up for yourself, but we’re simply not going to have the time to help everyone set up his/her My Medicare.

Complaints about the new revised PDF have been flooding into CMS, so we don’t know exactly how their new revised PDF is going to play out. There may be more revisions by October 1^st.

What’s really irritating about this is CMS’s timing. They wait until the busiest time of the year to foist their new change onto the public. If they would have chosen April, for example, we’d have six months to learn and understand their new website prior to the October AEP. They would have had six months to work out the bugs.

There is some good news here. There is a private prescription drug plan finder that will be available for agents but not for the public. We’ll still have to input your meds, but at least we’ll have a program that will assist us in making the most suitable recommendation for you. We’ll know more as we use this new PDF.

Big Prescription Plan Changes

CMS puts a gag on revealing specific plan information prior to October 1^st. By this we mean premiums and specific benefits. However, we can provide you some generalities prior to October 1^st.

Humana PDPs

For several years Humana has sponsored three PDPs. They have been as follows:

• Humana Enhanced PDP
• Humana Preferred PDP
• Humana Walmart PDP

Humana is scrapping those three plans and creating three NEW plans. They are as follows:

• Humana Premier PDP
• Humana Basic PDP
• Walmart Value PDP

The Premier plan will have the highest premium. The Humana Basic plan is intended for those on Extra Help from Medicare. (Extra Help is a federal program that subsidizes some or all of a beneficiary’s PDP premium and provides for lower cost copays. Qualification is based in income and assets or resources.)

The new Walmart Value plan will be the budget plan and will compete in the arena of lowest premium plans.

If you do nothing, here is what will happen in 2020. The people in the current Enhanced plan will be moved to the Premier Plan. Those with the Humana Preferred plan will be moved to the new Humana Basic plan. So far, so good.

Attention for those that have the current Humana Walmart plan.

The Humana Walmart members: If you do nothing, will be moved to the Humana Premier plan. You will NOT be automatically be moved to the new Walmart Value plan. Humana will be announcing this in your Annual Notice of Change (ANOC) letter that you’ll be receiving (if not already) from Humana. You may even receive a phone call from a Humana representative regarding this situation.

We will be contacting you as fast as possible to guide you into the most cost-effective plan for 2020. Please be patient, as we cannot service hundreds of people the first day, but we will get to you during the AEP. Also, please feel free to contact us, and we’ll put you on our list.

Aetna and WellCare

CVS bought Aetna, and the merger is complete. One of the obstacles prior to this merger was the concern by the regulators that CVS would have too strong of an influence regarding PDPs. CVS sponsors the Silver Script PDPs. So, to keep the regulators satisfied, Aetna sold off its PDP unit to WellCare. A few of you have already contacted us about the somewhat vague letter from WellCare explaining this situation.

Be sure to read the ANOC that you’ll be receiving from WellCare. Please contact us with any questions.

PDPHelper.com

We really appreciate the large numbers of you that have previously used PDPHelper.com as a method of submitting to us a list of your meds. Please continue to do so for this coming AEP. Our website is not affected by the changes on Medicare.gov.

Lastly, thank you for your continued business. It is your patronage that keeps us operating.

This 2019 AEP is our fourth year of using PDPHelper.com. The following are some tips to help us do an accurate search on your behalf for your 2020 Prescription Drug Plan (PDP). Our goal is to recommend the PDP that will be most suitable for you. This is especially important with the WellCare takeover of the Aetna PDPs and Humana revamping their plans.

Step 1

Please enter your name, phone, email address, your zip code, and your county of residence. Some zip codes span multiple counties, and that’s why we request your county of residence. This means where your residence sits.

Next, please list your top pharmacy choices. We also ask you if you would be willing to use Walmart, Walgreens, or a mail order pharmacy if that will save you money.

Step 2

In this section, only enter your pills, capsules, or tablets. Liquids, gels, creams, insulin, eye drops, patches, etc. are in the next steps.

Enter the name of your prescription, the dose, and the quantity you buy. Important, is the quantity you buy per one month, per every two months, per every three months, or per every twelve months? If you take something as needed, estimate how many pills you buy and how often you buy it. Your estimate does need to be exact. Just get it as reasonably close as you can.

Example #1—Betty take two, 500mg metformin tablets every day. She buys 60 every month.

Name of Prescription: Metformin
Dosage: Enter 500mg
Quantity: Enter 60
Frequency: Enter month

Example #2—John take hydrocodone/apap, 325/10mg, as needed for back pain. Some days he takes none but other days he takes two or three. He estimates he takes around 45 per month

Name of Prescription: Hydrocodone/apap
Dosage: Enter 325/10mg
Quantity: Enter 45
Frequency: Enter month

Step 3

The section is for Insulin, Inhalers and Nebulizers

Example #3—Alice uses insulin. She checks “yes”. She enters her information as follows:

Name of insulin: Lantus Solostar pens
Size: 3 mL
Quantity: 5 pack or just 5
Frequency: per 2 months

Example #4—Shirley uses Advair. She checks “yes” for the category: “Do you use any inhalers or nebulizers?” She enters her information as follows:

Name of inhaler: Advair
Size: 250/50
Quantity: 1
Frequency: 1 month

Step 4

This final step is for Eye Drops. Gels, Creams, Lotions or Salves, and Other Prescriptions.

Example #5—Mary uses eye drops. She checks “yes” for this category and fills in her information. Please do NOT attempt to say “2 drops per eye each day.” We need to know the size of the bottle, usually 2.5 mL, 5 mL, or 10 mL and how often you fill your prescription.

Name of eye drops: Latanoprost SOL 0.005%
Size: 2.5 mL
Quantity: 1
Frequency: 1 month

When finished, please hit the submit button. Thank you in advance for using PDPhelper.com. End

by Dr. David Eifrig

221 million prescriptions…

That’s the latest number available for the number of prescriptions written in a single year (2012-2013) for statins.

In a little more than a decade, from 2002 to 2013, use of this cholesterol medicine increased 80%. The reason? The American Heart Association lowered the guidelines for “normal” cholesterol numbers. Overnight, millions of Americans suddenly had high cholesterol… and doctors turned to Big Pharma to “fix” the problem.

Today, one in four Americans over the age of 40 takes statins. That number makes my blood boil. Particularly when friends of mine resign themselves to taking the drug for the rest of their lives.

I’ve written before about the big myth behind cholesterol. Solely treating a set of numbers with an overprescribed drug class like statins is an irresponsible – and dangerous – practice.

That’s largely due to the fact that inflammation – not cholesterol – is the root cause of heart disease. That’s why simply treating cholesterol numbers doesn’t work. Doctors need to focus on the whole patient – including lifestyle elements like diet and exercise.

But given how many folks still write to me asking about statins, I wanted to address my views on them in today’s issue. Let’s get started…

Please click here to keep reading.

The following are my comments.
by Lance Reedy

My comments: What are these processed foods that Dr. Eifrig refers to? For several years I have used the acronym SORF to describe these unhealthy foods that Dr. Eifrig and others refer to. If you avoid processed foods with one, two, or all three components of SORF you will go a long way to avoid inflammation-causing foods. Sadly, there are hundreds of these dressed up packages sitting on grocery store shelves that unsuspecting shoppers unwittingly purchase.

S = Sugar   This includes sugar, high fructose corn syrup (HFCS), and sugar alcohols. Even though artificial sweeteners such as aspartame, Splenda, etc. aren’t sugar, they are toxic chemicals that you don’t want in your body. Don’t forget the Agave scam. Agave is high in fructose. The over-consumption of these sugars can lead to insulin resistance and metabolic syndrome.

O = Oils   This refers to oils that require a factory to produce. Included in this list are soybean oil, canola oil, safflower oil, corn oil, etc. The industrial processing causes these unstable Omega 6 oils to become rancid. This causes harmless, low-density lipoproteins to become oxidized and transformed into small, B-B-like particles. These particles, in turn, cause inflammation to the lining of your coronary arteries. Please refer to Dr. Stephen Sinatra’s The Great Cholesterol Myth.

What about the advertising the suggests that these oils are heart-healthy? At best they are bogus, and at worst they are fraudulent propaganda.

RF = Refined Flours   This list includes white flour or “enriched” white flour, white rice, or any product made by milling off the bran and germ of any grain. The refining process robs the grains of valuable B vitamins and fiber. Worse, it concentrates the starch, causing your blood sugar to spike as if you had eaten sugar. Again, this contributes to insulin resistance and metabolic syndrome.

Want to stay in optimal health and avoid as much inflammation as possible? Avoid SORF!

Disclaimer

The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Not quite.

Note: I thank Ron Iverson, president of NAMSMAP* for assembling this data. This information comes from the National Association of Insurance Commissioners. *National Association of Medicare Supplement and Medicare Advantage Producers. This article is a revision from one published earlier this year.

A Brief Summary

Plans C and F will not be available for people turning 65 after January 1, 2020. People on Medicare prior to that date can still purchase Plans C and F, subject to medical qualification in most cases. If you’re not a detail person, you can to stop here. For the mavens that enjoy knowing the full details, keep reading.

Now the Details and the Long Version

1)  Why is the standard model for Medicare supplement (Medigap) plans being revised?

A new federal law was passed on April 16, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medigap policies that cover the Part B deductibles for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.

2) What does MACRA require?

As of January 1, 2020, MACRA does the following:

2a) Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries, so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan.

2b) Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.

2c) Who is considered a “newly eligible” Medicare beneficiary under MACRA?

MACRA defines “newly eligible” as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

3) How much is the Medicare Part B deductible?

Medicare Part B deductible is $185 in 2019.

4) How does this relate to efforts to eliminate Medigap or Medicare supplement “first dollar coverage”?

This accomplishes the efforts to eliminate Medigap “first dollar coverage” (coverage of all claims without paying any out of pocket cost) by discontinuing sale of Plan C and Plan F only for “newly eligible” Medicare Beneficiaries

5) How are people eligible for Medicare on the basis of disability impacted by these changes?

Current beneficiaries are not impacted. The restrictions under MACRA apply to persons who qualify for Medicare as a result of a disability on or after January 1, 2020.

6) Why are plans “re-designated” for only “newly eligible” Medicare beneficiaries?

The Federal Government wanted to eliminate coverage for the Part B deductible making consumers responsible for that first dollar coverage. The only difference between Plans C and F and Plans D and G is the coverage of the Part B deductible under Plans C and F. All other benefits are exactly the same for D and G. Since Plans C and F will no longer be available for “newly eligible” beneficiaries, it was necessary to designate Plans C and F as Plans D and G for these individuals.

7) How are enrollees in current Plans C and F affected by these changes?

Current enrollees (those eligible for Medicare PRIOR to January 1, 2020) can continue with their Plan C or Plan F, including F High Deductible plan, and may continue to buy Plans C and F beyond January 1, 2020. Current enrollees will also be able to buy the new Plan G High Deductible plan on or after January 1, 2020.

8) What changes are made to High Deductible Plan options?

Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020. The effective date of coverage for Plan G High Deductible must be on or after January 1, 2020. If you are not a “newly eligible” beneficiary and are enrolled in a Plan F High Deductible prior to January 1, 2020, you are able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.

9) When can the new High Deductible Plan G be sold and who can buy it?

Plan G High Deductible can be made available beginning on January 1, 2020; “newly eligible” Medicare beneficiaries and current beneficiaries would be able to buy the new Plan G High Deductible.

10) For high deductible plans, does payment of the Part B deductible count towards the plan deductible?

For Plan G High Deductible; while the Part B deductible is not covered (reimbursed), it does count towards the High Deductible plan’s deductible. If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses and Part B Deductible expenses are then incurred, these expenses will not be covered expenses until the beneficiary meets the Medicare Part B deductible.

11) For the new High Deductible Plan G sold on or after January 1, 2020, what happens if a policyholder meets the high deductible amount with all Part A out of pocket expenses?

If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses any Part B Deductible expenses incurred will not count towards meeting the High Deductible nor will they be covered expenses.

12) What changes are made to Guaranteed Issue requirements?

Since two of the current guaranteed issue plans, Plans C and F, will no longer be available for “newly eligible” Medicare Beneficiaries on or after January 1, 2020, Plans D and G will become two of the guaranteed issue plans for these individuals. Current enrollees can remain with or buy Plans C and F and individuals who do not fall within the definition of “newly eligible” Medicare beneficiary will still be able to purchase Plans C and F.

13) How does this change the way Plans C or F, and D or G, may be sold in the state?

Insurers can continue to sell Plans C or F to current Medicare beneficiaries. However, “newly eligible” Medicare beneficiaries cannot apply for or purchase Plan C or F. The “newly eligible” would be offered Plans D or G on a guaranteed issue basis instead. All other currently available plans may continue to be offered to all Medicare beneficiaries regardless of their date of eligibility for Medicare.

You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.  

Key Takeaways

1)  Plans C and F, and High Deductible F, will not be available to anyone who turns 65 (“newly eligible”) after January 1, 2020, including those eligible for Medicare by reason of disability.

2)  People currently with Plans C and F and High Deductible F will be able to keep them after the date.

3)  People who turn 65 and register for Medicare before the date, can still purchase Plans C and F because they are not considered “newly eligible.”

4)  And…even though a person who purchases Part B after January 1, 2020, they can still purchase Plans C or F because he/she turned 65 before the date.

5)  The current Plan C will become (be designated) the current Plan D after the date.

6)  The current Plan F will become (be designated) the Current Plan G after the date.

7)  All High Deductible Plan Fs will be available as they currently are after the date, and will become (be designated) High Deductible Plan G.  Available purchase will include people who turn 65 before the date, but again, not those “newly eligible.”

8) Guaranteed Issue (GI) Plans C and F will not be allowed to be sold to newly eligible, but GI plans D and G will.

9)  Plans K and L will remain the same, with the exception of the yearly raise of out-of-pocket expense.

10)  Plans M and N will not change.

11)  The rules also apply to “Medicare Select” plans.