Posted by: Susan Polk | January 26, 2016

2016 Update To Medicare/Medicaid

San luis obispo medicare–Susan Polk Health Insurance Company recently released a report on the new changes that Medicare San Luis Obispo users can expect to see in 2016. To view the report, see below.

The two most significant changes will directly impact many San Luis Obispo seniors who rely on Medicare health insurance and whose monthly income includes social security benefits. Social Security declared that there would be no cost-of-living adjustment (COLA) for the upcoming year. In the last 40 years, this is only the third time that COLA has not been included in social security payments.

Those who presently have their Medicare premiums withdrawn from their social security payments and are not subject to income-related additional changes will continue to pay $104.90 per month. For all others, including those who pay their Medicare premium directly, and for those with higher income, the new, basic premium will be $121.80.

The premium for Part B of the Medicare health plan, which covers doctor’s visits and outpatient care, has been based on the beneficiary’s income since 2007. This means that those with higher incomes will pay a higher premium for Part B of Medicare in 2016 than they have in past years. This increased premium also affects new enrollees to the Medicare plan. While the 2015 premium was $104.90, the 2016 premium will be $121.80.

In addition, San Luis Obispo Medicare users will see increases in the deductibles and copays for Medicare benefits in 2016.

Many beneficiaries are confused and afraid of the financial impact of these 2016 Medicare changes. The Medicare San Luis Obispo specialists at Susan Polk Health Insurance Agency offer comprehensive health insurance plans which cover deductibles and copays, giving Medicare enrollees the protection and assurance they need. Medicare beneficiaries who work with Susan Polk feel confident in their future, knowing that their health expenses are covered through the most cost-effective plans.

For more information on how to get the most suitable Medicare plan, call the specialists at Susan Polk Health Insurance Agency at (805) 544-6454.

Posted by: Susan Polk | January 26, 2016

2016 Healthcare and Medicare Trends

medicare san luis obispo

– The New Year will likely usher in some expected (and unexpected) trends in healthcare practices and changes to Medicare. In a new recently released report, Medicare San Luis Obispo specialists at Susan Polk Insurance have compiled some of the (soon-to-be) most talked about issues affecting the healthcare system.

The report outlines these three healthcare trends and Medicare changes to watch out for in 2016. To view the report, see below:

Healthcare and mobile apps. With technology being an integral part of our everyday lives, it is no wonder that healthcare providers are looking for ways to make healthcare accessible – on the go. According to Pew Research, in 2015, over 30-percent of adults used at least one health-related app on their mobile device. This trend is expected to increase and the healthcare industry is looking for new ways to engage health consumers. 2016 could be the year of handheld medical technology that all consumers have access to through their smartphones.

Medicare Part B changes will impact premiums. This is a big change and could affect upwards of 30-percent of Medicare Part B participants. Those who do not pay their Part B premium directly out of their Social Security check and instead pay for Medicare directly themselves are in for an increase! The Medicare Trustees Report released in 2015 projected the expected premium increase to be in excess of 50-percent; however, a last-minute budget deal limited the increase.

Income categories for those paying the income-related monthly adjusted amount (IRMAA) have not changed since 2010. The threshold of $85,000 for individuals and $170,000 for couples will remain until 2019. This will increase the numbers paying this penalty from 5.1% in 2012, to about 9.7% in 2019. Previously, the maximum anyone would pay was 65% of the actual cost of Part B expenses. Today, the percentage is 80% for the highest income earners.

Several companies have recently announced rate increase for California Medicare Supplements. For those enrolled in Plan F in San Luis Obispo County, they can expect rate increases of about 8% in 2016.

There are several strategies for improving one’s financial position, including:

  1. Taking advantage of the California Birthday Rule. Within 30 days of your birthday, you have an Open Enrollment to move to a like or lesser plan regardless of your health.
  2. Considering a downgrade to a lower benefit plan. While Plan Fs are expected to increase an average of 8%, Plan Gs are showing greater stability with no increase expected for most companies.
  3. For some Medicare beneficiaries, a Medicare Advantage Plan may provide the coverage they need. We recommend Medicare Advantage plans for those who meet certain criteria, including (a) limited income, (b) older folks who would not want to travel outside the area for specialty care, (c) in hospice or long-term care facility.

About Susan Polk

Since 1988, Susan Polk Insurance has provided exceptional customer service to her clients. Specializing in health insurance plans, Susan Polk’s healthcare and Medicare San Luis Obispo team, time after time, are able to find the lowest cost plans to meet their client needs. Partnering with health and life insurance agents nationwide, Susan Polk Insurance provides a wide range of offerings for Medicare Plans, life insurance, long-term care insurance, travel, and international insurance for San Luis Obispo residents and beyond.

For more information about this report and other Medicare changes, call the Medicare San Luis Obispo experts at Susan Polk Insurance today at (805) 544–6454.


Posted by: Susan Polk | May 29, 2015

Why would a senior citizen need life insurance?

SeniorsMost Americans need life insurance, although it is probably one of the most overlooked types of insurance available, and senior citizens are no exception.

“There are many different reasons that a senior may choose to have life insurance,” said San Luis Obispo life insurance provider Susan Polk.

Here are some of the most common reasons that a senior would choose to purchase life insurance:

• Paying for last expenses
Losing a loved one is hard enough, but consider that funeral costs and other death related costs could add up to thousands of dollars for the survivors. Life insurance
can cover these expenses.

• Paying for additional costs of long‐term care
When selecting a life insurance policy, there are options that you can choose that allow for long‐term care expenses to be paid for by the life insurance policy. Some options include:
‐Combination products
You can purchase a life insurance/ long‐term care combination plan to assure that all of the benefits of the policy will be paid.
‐Accelerated death benefits
There are different types of accelerated death benefits that serve different purposes. Some life insurance policies include a feature that allows a tax‐free advance of benefits should you become terminally ill, have a life‐threatening diagnosis, need long term care or are confined to a nursing home. Sometimes    policies require an extra premium for this feature.

• Equalizing monies left to heirs
You can use your life insurance policy to equalize inheritance. “For example, if one child is left an interest in a home or business, you might name other child(ren) as beneficiaries of a life policy to provide cash that would make it fair.”

• Making up for the loss of income (social security or pension) when one spouse dies
If you are dependent on funds from a spouse from income, social security or a pension, life insurance policies can help to make up for the loss of those funds should that spouse die.

• Leaving a legacy to a church or favorite charity
Life insurance is a great way to donate to a church or charity. You would simply designate that church or charity as the beneficiary of the policy.

• Helping put a grandchild through college
Donating funds through a life insurance policy towards a grandchild or other relative’s college cost is an effective way to support them without affecting their accessibility to financial aid.

Life insurance is a truly important facet in financial planning. Many seniors may think that they can no longer purchase a policy because of their age, and although there may be limitations, policies are still available for seniors regardless of their age.

For information about life insurance, call San Luis Obispo life insurance expert Susan Polk today (805) 544‐6454.

Susan Polk Insurance
(805) 544‐6454
1443 Marsh St
San Luis Obispo, CA 93401
United States

Posted by: Susan Polk | April 28, 2015

Disability insurance 101

Disability insurance

San Luis Obispo disability insurance expert Susan Polk asks, ‘How long would you be able to make it without a paycheck?’

What kind of situation would you be in if you suddenly couldn’t work? How would you pay your bills? Mortgage? Car payment? Support your family?

Polk said that most Americans wouldn’t even make it a month before having financial difficulties, and one in four Americans would have problems immediately.

According to a report by the Life and Health Insurance Foundation for Education entitled, “The Real Risk of Disability in the United States,” You actually have a three in 10 chance of suffering a disability that keeps you out of work for 90 days or longer at some point during your working career. And it’s not accidents that are the primary culprit. According to the Council for Disability Awareness, 90 percent of disabilities are caused by illnesses not accidents.

Many workers incorrectly assume that either the government or their employer provide disability insurance. California offers State Disability Insurance for most workers, but self-employed workers are not covered. Benefits are paid after seven days of disability, but only at 55%, and benefits end after one year.

The federal government provides a form of disability insurance through Social Security, but most would have to wait a year and a day to establish their disabled status and then expect some difficulty in becoming classified as disabled. Typically, it requires that you demonstrate that your medical condition prevents you from preforming any work at all, not just the job that you had held. A 25-year old worker with an income of $50,000 who becomes too injured to be able to work again would lose $3.8 million dollars within their lifetime. In 2013, only 33% of applicants were approved for Social Security Disability.

How much money would you need to get by without a paycheck? You’ll need to take into account not just bills, but most likely debt, living costs, and dependents. Not to mention, you will most likely be facing medical bills and expenses as a result of the injury.

An individual disability policy provides the most protection for an individual or family. You can even protect your own occupation and can include inflation protection in case your disability is long-term. Premiums vary, depending on the amount insured, the benefit period, and the waiting period or deductible. Benefits can be tailor-made to fit your situation and your budget.

Disability insurance provides peace of mind, so that you know that you would be covered if you suddenly can’t work because of an illness or injury.

Call San Luis Obispo disability insurance expert Susan Polk for a free disability analysis at (805) 544-6454.

Susan Polk Insurance
(805) 544-6454
1443 Marsh St
San Luis Obispo, CA 93401
United States

Drawing from Susan Polk’s experience and knowledge as a licensed life and health agent since 1971, San Luis Obispo County insurance Agency specializes in helping clients navigate the maze of Medicare plans.

As the summer months make way for the cooler days of autumn, the professionals at Susan Polk Insurance Agency, Inc. would like to remind seniors in San Luis Obispo County and across the state of California that now is the time to start planning for the upcoming Medicare Open Enrollment period which starts October 15 and continues through December 7, 2014.

“There is a limited amount of time to make a decision about how to receive your Medicare,” said owner Susan Polk. “Every Medicare beneficiary, unless on a retiree group plan, should review his or her Medicare plan during the October through December time frame.”

Medicare specialists

As Medicare specialists with years of experience assisting seniors with difficult choices, Polk and her team of insurance professionals are eager to share their knowledge. The Initial Enrollment Period, according to Polk, starts three months prior to getting Medicare which is usually the first of the month in which you turn 65, the month you get Medicare, and three months after Medicare becomes effective.

“You usually get Medicare the first of the month in which you turn 65, but if you or your spouse are working, you may be able to defer enrollment into Part B until you or your spouse retires,” said Polk. “However, if you work for a small employer – less than 100 employees – you may need to enroll in Part B even if you continue group insurance as an active employee or as a spouse of an active employee.”

Those who miss the Initial Enrollment Period may have to wait until the General Enrollment Period, and remain uninsured for several months – just one reason why it is important to discuss plan options with a professional insurance broker at the Susan Polk Insurance Agency. Eleven standard Medicare Supplement Plans are available and offered through various independent companies.

“There are different rules for different folks,” said Polk, “and you will feel more comfortable being guided through the maze of dates and eligibility periods by a professional insurance broker.  Don’t enroll if you don’t have to, but don’t miss the enrollment period if you do.”

In addition to being a card-carrying Medicare Member, Polk has extensive experience and knowledge when it comes to Medicare and has been a licensed life and health specialist since 1971. Four-year agency staff member Laurie Tonegato is the firm’s Customer Service Representative for Medicare in addition to being a Medicare Sales Associate with fellow staff member Cathy Fredriks.

Prescription Drug Plans and more

As with Medicare Supplement Plans, Polk, Tonegato, and Fredriks understand that navigating the many prescription drug plan (PDP) options can be a daunting task without the assistance of an insurance professional. For example, individuals insured through a group retiree program may jeopardize their plan by enrolling in a PDP.

“And with 34 plans in California to choose from, you will want to enroll in the plan which is best for your situation,” said Polk.

As the largest enroller in Medicare plans in San Luis Obispo County, the independent insurance brokers at Susan Polk Insurance offer Medicare Supplements and Medicare Advantage plans from any company which works with brokers. Currently contracted with over a dozen carriers who write Medicare Plans, they can enroll anyone into any of the 34 PDPs – and they also offer Medicare Advantage plans.

A wealth of knowledge in Medicare, along with their willingness to review their Medicare plans twice a year to ensure their clients are getting the most out of their health care dollars, is what sets the professionals at the Susan Polk Insurance Agency apart from other insurance brokers in the area.

“We love what we do,” said Polk. “We help Medicare beneficiaries all over the state of California and in seven other states as well.”

More about Susan Polk

Susan Polk graduated from Pitzer College with a bachelor’s degree in Economics. With 43+ years of experience as a licensed agent, Polk has lent advice to San Luis Obispo County residents for the past 26+ years as the owner of Susan Polk Insurance Agency, Inc. She is a member of the San Luis Obispo Chamber of Commerce, National Association of Insurance and Financial Advisors (NAIFA), and the National Association of Health Underwriters (NAHU).

Polk has several professional designations, including Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Registered Health Underwriter (RHU), Chartered Healthcare Consultant (ChHC), National Association of Health Underwriters Leading Producers Roundtable Lifetime and Qualifying Member, Soaring Eagle, and Certified Senior Advisor (CSA). She has served on the boards of Children’s Health Initiative, Long-term Care Ombudsman, Court Appointed Special Advocates, and Habitat for Humanity; is a member of the working group on implementation of the Affordable Care Act, and is a regular speaker on Health Care Reform and Medicare.

For more information on Susan Polk Insurance Agency, Inc. stop by 1443 Marsh St. in San Luis Obispo, CA 93401, call (805) 544-6454 or (800) 242-6454, or visit

With the historic enrollment of millions of newly insured people into health plans, we have experienced many hurdles along the way.  The first hurdle was getting through the glitches and shutdowns of the websites used for enrollment.  The second hurdle was actually paying the premium and getting proof of insurance – the ID card that you could show at the hospital, urgent care, lab, or doctor’s office.  Whew!  We’re insured!  We made it.  That sense of relief is premature for many, as we come to, The next hurdle—and it’s a major one—is finding a doctor to treat you.  Here we encounter several problems, including….

  • The “network” of contracted physicians is narrower than the traditional networks that we were accustomed to.  There are an estimated 50% to 70% fewer doctors in the new networks as compared to the old ones.  People are surprised to learn that the doctor they know and trust is no longer in the network.
  • The lists of participating providers are not always accurate.  Many providers who show up on the list are not actually taking the insurance after all.
  • The fewer doctors who are participating are not taking new patients.

If you are having trouble finding a doctor to treat you and your condition, there is a specific protocol we recommend for dealing with the situation.  Here are step-by-step instructions to get the care you need.

  1. Log on to the insurance company’s website. Search for providers in the specialty you want, and then call the doctor to confirm they are accepting the new “Covered California” health plans through the insurance company you selected.  If the answer is “no” try the next doctor on the list.  Please see directions on finding a provider at the end of this article.
  2.  If you have exhausted the list of providers you have received from the carrier website with no success, you can then call your carrier and tell them that you have called every physician on their list and are not able to find a doctor that is both accepting new patients and accepting the new insurance. The carriers have said that they are willing to help members find physicians that are accepting these new plans, or arrange for you to see a non-network physician at in-network prices.
  3.  Contact Health Consumer Alliance at (800) 675-8001.

Hopefully, you can complete these instructions before you need to see the doctor.  If your health is at risk, please don’t delay, get the care you need and proceed with the above directions after you get any urgently needed care.   We are here to help guide you through the process.  Please let us know if you need help in advocating for your care.   Instructions for finding providers: Here on California’s Central Coast, Anthem and Blue Shield are the two insurance companies providing coverage.  The only difference between Blue Shield and Anthem are the doctor networks.  The insurance plans are the same.  If you have specific doctors in mind, please look them up in the Anthem or Blue Shield “provider finder.” Here is the link to Anthem.  Click on “find a doctor” on the middle, right hand side of the page.  In the finder, at the top enter the doctor’s name or specialty, in the middle enter your zip code, and towards the bottom, when you choose your plan type/network, please scroll down and choose “pathway ppoX – individual.”  That will give you the doctors for the new ACA plans. Here is the link to Blue Shield.  Click on “find a doctor” in the middle of the page.  In the Blue Shield provider finder, you will need to click “select a plan” in the upper middle of the screen.  In the dropdown menu, select “2014 Individual and Family Plans.”  Again, that will get you into the correct network.  Click on ‘advanced search’ to enter a doctor’s name or specialty.  If you are looking up a doctor by name, the name must be spelled correctly or the system will not pick up the doctor.  Google is good for helping with the spelling of doctor’s names. University of California research hospitals are only in the Anthem network, while only Blue Shield provides coverage at Stanford. Anthem has only California providers, and you are covered outside of California for emergencies only. With Blue Shield, you are covered worldwide. Please call or email with any questions! 805-544-6454

Susan Polk Insurance helps clients find the right policy at the right time in their lives.

Oftentimes, the need for long-term care insurance is not discussed until an individual is faced with an injury or illness, according to San Luis Obispo, CA insurance agent Susan Polk. With the costs of care directly impacting families, it is essential to consider long-term care insurance long before these life events occur. To help better educate her clients and others throughout San Luis Obispo County, Polk has added a wealth of information on the topic of long-term care insurance to her website,

“I have the heart of an educator,” says Polk, “and I like to help people decide what will work best for their situation based on their family health history and their family situation. The need for long-term care assistance may come about because of an illness, disability, injury, or a terminal condition so it is important to be prepared with the proper insurance before these occur.”

Long-term care becomes more of a reality as a person ages. According to data compiled by the Social Security Administration shows the average life expectancies in the United States today are: a man reaching age 65 can expect to live until he is 84 and a woman turning age 65 can expect to live until she is 86. Outside these averages, the data further shows that approximately one in four of these individuals will live past age 90, and one in 10 will live past 95.

In order to assure a higher chance of eligibility and lower-cost premiums, the best time to buy long-term care insurance, according to the AARP, is likely when an individual is entering middle-age and is still in relatively good health. Planning ahead can also result in lessening the dependence on friends and family at a later date.

“Many people do not realize just how prevalent the need for long-term care is,” says Polk, who has been writing long-term care policies for 25+ years. “I want to bring awareness to the need for obtaining  coverage sooner rather than later. The most ideal time to start a program is when a person is in their 50s; many financial advisors say by age 60.”

Some of the average costs in the United States for long-term care such as nursing and medical assistance, according to, include:

  • $205 per day or $6,235 per month for a semi-private room in a nursing home
  • $229 per day or $6,965 per month for a private room in a nursing home
  • $3,293 per month for care in a one-bedroom unit in an assisted living facility
  • $21 per hour for a home health aide
  • $19 per hour for homemaker services
  • $67 per day for services in an adult day health care center

Long-term care insurance includes coverage for in-home assistance, visiting nurses, community programs, adult day care, nursing home care, hospice, board and care facilities, and assisted living services in a residential community.

The experienced and dedicated team at Susan Polk Insurance is committed to helping their clients feel safe and secure about their future and work to find the best choices for their future needs.  . Many plan options qualify for the California Partnership for Long-term Care program that allows policy holders to maintain a higher level of assets in their estate, even if they eventually need Medi-Cal to cover costs.

To assist new and existing clients, Susan Polk offers no-cost, personalized assessments for those seeking answers to their questions on long-term care insurance at her San Luis Obispo office. Contact her at (805) 544-6454, or go to to learn more.



Posted by: Susan Polk | May 16, 2014

Protect your future with long term care insurance

Long term care insurance may be one of the most important financial planning tools you can use to protect your future.   Many individuals find themselves unsure of what it is and if they need it. Susan Polk Insurance is here to educate you and help you make the appropriate decision.

Long term care insurance is a policy you purchase to protect your income and assets from the potentially devastating costs of being cared for or caring for a loved one, should a long term illness or condition arise. Planning ahead will allow you and your family to remain focused on quality time together instead of struggling to pay for needed care.  One in two people will need long term care at some point in their lives, yet few have prepared for it.  Using assets or income already allocated for other purposes can put a strain on your financial plan. An earmarked asset can be vulnerable to market volatility, which can jeopardize your plans and put a burden on any income and assets you might plan to use. 

Do you want to stay at home and have your care there, or would you prefer an assisted living facility or adult day care?  There are many options for care both at home and in the community, and having long-term care insurance offers you the freedom to make these decisions and many more.

When you purchase a long term care policy, your rates are based on your age at the time of purchase, so the longer you wait the more expensive it can become.   While the best time to purchase this insurance is in your mid 50 to early 60’s, it is never too early or too late to start planning for the future.

In addition to traditional long term care plans, we also offer California Partnership plans, which offer additional asset and inflation protection.  With a Partnership plan, it is possible to protect assets you might wish to pass on to your heirs.  This type of plan is fast becoming the most popular for homeowners in San Luis Obispo County, giving them the security to know that their assets are further protected.

Long Term Care Insurance can:

  • Pay for long-term residency in Assisted Living and Skilled Nursing Facilities, Board and Care Facilities, Memory Care Facilities, and Adult Day Care.
  • Pay for in-home care.
  • Be purchased as a daily or monthly maximum benefit amount.
  • Include inflation protection, which we recommend.
  • Also, be issued as joint policies and shared care benefits to leverage your premium dollars.

Understanding your options and having a real plan is vital to protecting your future and your assets. Susan Polk Insurance is here to guide you through the process and help you choose the right plan for you, your family, and your budget.

For further information and to learn more about this important insurance; please call Susan Polk Insurance (805) 544-6454.


Posted by: Susan Polk | February 5, 2014

Rate Increases

Have you ever wondered why health insurance rates seem to increase without rhyme or reason?  Let’s see if we can make health insurance rates a little less mystifying.

  • Grandfathered Plans

If a plan has “Grandfathered” status, it was purchased prior to March 23, 2010 (the date the Affordable Care Act was signed).  These plans follow the old rules regarding rate increases, which are:

– Notification of increase must be approved by the State Department of Insurance or Department of Managed Health Care.

– Rates are adjusted (up or down) based on the medical expenses from everyone who has a particular plan in a particular region.  All plans must pay out a minimum of 80% of premiums to claims.

– Rates cannot be adjusted because of one individual’s medical expenses.

– There is no specific rate guarantee.

For everyone who has a plan which conforms to the Affordable Car Act (all new individual plans beginning 1/1/14) the rules are:

– Rates are adjusted annually when the policy renews (January 1).

– Rates are based on a person’s age as of January 1.  There are no more age brackets, age rate increases happen each new year.

– Rates are adjusted (up or down) based on the medical expenses from everyone who has a particular plan in a particular region

Posted by: Susan Polk | February 5, 2014

Medi-Cal & Asset Recovery

I recently had an interesting question from a client.  He asked, “If I’m on Medi-Cal can the state go after my assets when I die?”

What is Medi-Cal?

Medi-Cal is a federal / state welfare program providing medical and long-term care for low income residents of California.  Because it is a form of welfare, the state’s mandate is to provide the services only to those who have financial need.  So if someone did receive the benefit, but could actually pay for it themselves, the state reserves the right to pursue re-payment for any medical expenses that incurred after someone turned 55.

The changes the Affordable Care Act brings complicates this policy.  Prior to 2014 there was an asset test, but as of January it has been abolished.  The new law, and by practical application Covered California, moves people from private insurance to Medi-Cal if their income is too low … with no consideration of their assets.

So we have a whole new group of people on Medi-Cal who could be at risk of having their estates pursued by the state.  They didn’t choose to be on Medi-Cal and may prefer to have private insurance, but the system automatically puts them on Medi-Cal.  And now their estate may be in jeopardy.

  • Is there a solution?

The only solution is a legislative one.  While Medi-Cal estate recovery is part of a federal law, the State of California could provide legislative clarification that the estate recovery applies only to those receiving long-term care services and not to those receiving medical coverage.

We strongly recommend contacting your state legislators to encourage them to provide such a legislative fix.

  • Quick facts:

Medi-Cal qualification is based on a family’s Modified Adjusted Gross Income (MAGI).  For most people, their AGI is the qualification determinator (line 37 on a 1040 form).

Family size         Medi-Cal MAGI (less than)

1                        $15,917
2                        $21,559
3                        $27,147
4                        $32,735
5                        $38,322
6                        $43,910

Estate Recovery applies to:

• Medical Expenses occurring after turning 55 years old

Long Term Care expenses regardless of age

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