What’s new in 2021?

One of the top three insurance carriers in California will be offering a new Medicare Advantage Plan (HMO) in Santa Barbara area with a $0 monthly premium. Since this is an HMO plan, you will need to have your Primary Care doctor at Sansum Medical Clinic and you will only be able to use doctors at Sansum; The network hospital is Cottage Hospital. There will be copays for most medical and hospital services.

This plan will be available starting January 1, 2021. Enrollment can only occur during the Annual Open Enrollment that goes from October 15 to December 7, 2020.

Most of our clients have Medicare Supplement Plans.
For my many years in the business I have recommended: Always get the best Medicare plan that fits “comfortably” in your budget.  Remember, you are buying insurance that will last a lifetime and pay all your expenses.  There is no way to predict your health expenses in your 80’s or 90’s.

  • If you like your current plan and it fits “comfortably” in your budget, keep it. It is the best plan, and will not change over a lifetime.
  • If your plan premium is becoming “uncomfortable” in your budget, call us to see optional plans that are more affordable.
    • For example, the Covid Pandemic or other circumstance may have created a need for a lower cost plan, and a more affordable HMO option may be appealing.
    • Caveat: If you change to an advantage plan (HMO), and later want to go back to the Medicare supplement, you will need to answer medical questions, and could be denied the change if you have a pre-existing medical condition.

To make it simple for you, I have listed reasons for choosing a Medicare Supplement or an Advantage plan. Take a moment now to read these items.  In a couple minutes you will know what is best for you.

When does a Medicare Supplement make sense for you?

  • Budget: a Medicare supplement premium fits “comfortably” in your budget. If yes, you should keep your plan. This is the best plan on the market.
    • Note: If you were under age 65 or had employer coverage, a plan comparable to a Medicare Supplement would cost around $1800/month.
  • Choice: you want to have access to any doctor or hospital in the Medicare national network.
  • Prescriptions: you need to buy a separate prescription drug card.
  • Out-of-pocket risk: Medicare Supplement plans pay all your medical  bills for a lifetime.
  • Stability: These plans are defined by the government and cannot change in the future. You can keep your plan for a lifetime.
  • Insurability: If the Medicare supplement becomes too expensive in the future, you can enroll in Advantage plan any year during the Annual open Enrollment (October 15 to December 7). To return to the Medicare supplement after one year would require medical questions, and your requested change could be denied for a pre-existing condition.

When does an Advantage plan make sense for you?

  • Budget: A Medicare supplement does NOT fit comfortably in your budget. For example, due to Covid virus your budget has changed and your supplement premium is no longer comfortable.
  • Choice: You already use Sansum doctors for your medical services; or you are willing to change to a network limited to Sansum physicians.
  • Prescriptions: a prescription drug card is included with plan.
  • Out-of-pocket risk: there is an annual out-of-pocket risk of $3,000. For example, if you are hospitalized, you have $180 copays per day for the first five days. And for certain procedures you pay 20% up to the $3,000 maximum.
  • Stability: Every year the insurance company can make small changes to copays.
  • Insurability: If you change to an Advantage plan, and later decide to return to your old Medicare Supplement, you may have to answer medical questions and the Medicare Supplement insurance company could decline your request.

What if you are in doubt?

If you are not sure, it may be best to think about it for a year.  You can enroll in an Advantage plan every year during the Annual Open Enrollment that goes from October 15 to December 7.

We can help you make a change

If you want to make a change, please call us to make an appointment. We represent the top 3 insurance companies selling Medicare products in California so you will always have good choices.