Medicare San Luis Obispo

–Susan Polk Insurance, Inc., the provider of insurance for Medicare in San Luis Obispo, has summarized the “hold harmless rule” and it’s relationship to cost of living adjustments (COLA) and Medicare Part B premium increases. “This rule protects most Social Security recipients,” said agent Susan Polk, “and we think it is important that everyone understands how they are protected.”

The Medicare hold-harmless rule and how it protects Social Security recipients

Most Social Security recipients are protected from reductions in their monthly benefits due to increases in Medicare Part B premiums. This protection is known as the “hold harmless rule.” The rule comes in to play depending on the amount of the cost of living adjustment (COLA) and the Part B premium increase.

Both Part A and Part B are part of original Medicare.

  • Medicare Part A covers Medicare inpatient care, including hospital, skilled nursing facility, and, in limited circumstances, at home. Part A is generally included as a Social Security benefit and the recipient does not pay premiums, except under certain conditions.
  • Medicare Part B covers services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. There is a premium for Part B that is deducted from monthly Social Security benefits.

For 2018, the Part B premium increased from $109 to $134 for most Social Security recipients. Considering that about 63 million Americans are receiving Social Security retirement or disability benefits and the average retiree benefits are $1,404 per month, it’s easy to see that deducting any additional amount from an already low income can have serious impact.

The hold-harmless rule ties any increase to Part B premiums to COLA. The rule ensures that Part B premiums cannot increase more than the previous year’s COLA in Social Security benefits. In other words, an increase in Part B premiums cannot reduce the amount of monthly Social Security payments.

This being said, not everyone is protected. The Polk Insurance Agency hopes to set its Medicare San Luis Obispo clients at ease by helping them understand how the hold-harmless rule protects them.

Who is and who is not protected?

The hold-harmless rule protects you if you were enrolled in Part B before 2017 and the premiums are deducted from your Social Security payment. Even though, for most, the Part B premium increased to $134 for 2018, the 2-percent COLA resulted in a small increase in benefits as well as covering the premium increase.

It does not protect those who are:

  • Delaying Social Security benefits but benefiting from Part B
  • The 5-percent of Social Security recipients with an annual income higher than $85,000

The 2018 Part B premium increase for those not covered by the rule is between $187.50 and $428.60. The premium increases based on income with the highest paid by those with incomes over $214,000 (or $428,000 for couples).

Learn more

To learn more about Medicare coverage and Medicare insurance plans, contact Susan Polk Insurance. Medicare insurance plans must offer at least the same coverage as original Medicare. The agents at Susan Polk Insurance, Inc. are dedicated to helping people find affordable insurance that offers the best protection.

Susan Polk Insurance Agency, Inc.

1443 Marsh St.

San Luis Obispo, CA 93401

(805) 544-6454

Press release is by San Luis Obispo SEO company Access Publishing, 806 9th Street, #2D, Paso Robles, CA 93446, (805) 226-9890.

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Medicare San Luis Obispo

–Medicare, launched in 1966, was a landmark advancement in health care for the United States. The staff at Susan Polk Insurance, Inc., providing insurance plans for Medicare in San Luis Obispo, would like the public to know more about the history of Medicare.

Medicare then and now

A little-known fact today is that “Medicare” was originally the “Dependents’ Medical Care Act,” that was passed in 1956 to provide medical care for families of military personnel. Four years later, in 1961, President Dwight D. Eisenhower held the first White House Conference on Aging during which a health care program for social security beneficiaries was proposed. Congress enacted Medicare and Medicaid in July 1965 under Title XVIII of the Social Security Act. President Lyndon Johnson signed the bill into law on July 30, 1965. The bill provided health insurance to people age 65 and older regardless of income or medical history.

The first two people to become Medicare recipients were former President Truman and his wife, former First Lady Bess Truman. President Truman paid $3 per month for their Medicare coverage, which was deducted from his monthly social security payments.

The Medicare program is operated and monitored by the federal Centers for Medicare and Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS). CMS also monitors Medicaid programs that are offered by each state.

In 1966, Medicare ended the racial segregation in thousands of waiting rooms, hospitals, and physician practices by making payments to health care providers conditional on desegregating services and facilities.

History is important

History is important because it is helpful to know how things came to be and the influence something from the past has today. With at least 55,000 people receiving Medicare in San Luis Obispo County and another 67,000 in Santa Barbara County, The Polk Insurance Agency would like to share the origins and benefits of Medicare not only with the Central Coast communities, but elsewhere.

Learning more about Medicare. Its origins and how the program has improved health care for so many American’s brings the significance of this program to an entirely new generation who, in turn, will benefit from Medicare in the future.

Who pays for Medicare?

Medicare is funded from two trust funds held by the United States Department of Treasury:

  • The Hospital Insurance (HI) Trust Fund that pays for Medicare Part A benefits and Medicare program administration, including fighting fraud and abuse.
  • The Supplementary Medical Insurance (SMI) Trust Fund that pays for Part B and Part D benefits and Medicare program administration, including fighting fraud and abuse.

The HI Trust Fund is funded by payroll taxes shared by employees and employers, taxes on self-employed people, income taxes on social security benefits, Part A premiums from people who are not eligible for free Part A and interest earned on the trust fund investments.

Medicare Part B and Part D premiums along with funds authorized by Congress and other sources such as interest earned on the trust fund investments fund the SMI Trust Fund.

Beginning in 1966, workers paid 0.35 percent of their earnings into the Medicare system. The Medicare tax hit 1-percent in 1973 and the current 1.45-percent went into effect in 1986. Employers pay a matching percentage.

Beginning in 2013 workers earning more than $200,000 ($250,000 for couples) paid an additional 0.9-percent. Self-employed workers pay 2.9-percent of earned income into the trust fund.

As a point of interest, in 2014 just the Part A contribution of local workers and employers to Medicare from San Luis Obispo County was more than $7 million.

What Medicare has meant to Americans

Before Medicare older adults often paid over three times as much for health insurance as younger people. Approximately 60-percent of people over 65 had health insurance, but the rest could not afford it. Today, many are eligible for dual coverage by both Medicare and Medicaid.

By July 1966 more than 19 million people were enrolled in Medicare, or roughly 8-percent of the United States population for that year. Today, Medicare serves approximately 56 million people, or 17-percent of the population.

Congress expanded eligibility to younger people with permanent disabilities, for people with end-stage renal disease and in 2001 to cover younger people with Lou Gehrig’s disease. Over the years, Medicare has included benefits for speech, physical and chiropractic therapies.

In the 1980s the options of payments to health maintenance organizations (HMO) was added. The HMO option was formalized in as Part C under the Balanced Budget Act 1997. Medicare Part D was passed and signed by President George W. Bush in 2003.

With Medicare Part C recipients began choosing coverage from private plans. The Susan Polk Insurance Agency specializes in serving Medicare-eligible people by helping them navigate the private plan system and offering plans to provide them with the best possible access to health care.

Susan Polk Insurance Agency, Inc.

1443 Marsh St.

San Luis Obispo, CA 93401

(805) 544-6454

Press release is by San Luis Obispo SEO company Access Publishing, 806 9th Street, #2D, Paso Robles, CA 93446, (805) 226-9890.

Medicare Plans San Luis Obispo

–San Luis Obispo Medicare plan specialists, Susan Polk Insurance Agency, is reminding Medicare recipients that the current program providing equitable relief for enrollment delays due to national and state-level disasters is ending on May 31, 2018. “It is important that people who were not able to enroll in Medicare due to California fires or flooding do so at once,” said agency owner, Susan Polk.

Polk has also summarized and simplified the procedures for getting medical care and medication during disasters and emergencies. “This is a checklist for Medicare recipients to print out and keep handy so that the information is easily available if it is ever needed,” said Polk.

Polk said the information is available to the public on the Medicare website, “But, people don’t always have access to a computer during a disaster. Keep copies of this checklist wherever it will be handy, in purses or wallets, in vehicle glove boxes and give copies to relatives so you’ll have the information when you need it.” In addition to the checklist, Polk also advises that people contact their individual plans to find out the best way to keep premium payments current during a disaster. Also, replace lost Medicare and insurance cards as soon as possible.

The checklist includes:

  • Contact information for obtaining equitable relief before the deadline
  • How to get medical care, including dialysis and cancer treatments
  • How to get prescriptions filled
  • How to get emergency replacements for medical equipment
  • What to do if you miss the enrollment period

Equitable relief contact information

Medicare also offers equitable relief to people who were not able to meet Part A or Part B enrollment deadlines due to national or state emergencies. The current equitable relief period is ending May 31, 2018.

To request equitable relief, Polk urges Medicare recipients to:

How to get medical care

Recipients can see a doctor and continue to receive dialysis and cancer treatments during an emergency. The following information provides telephone numbers and websites to contact with questions and for assistance.

For original Medicare

  • Call Medicare at (800) 633-4227 for information about seeing a doctor or for contact information for the local ESRD (End Stage Renal Disease) Network.
  • Visit the ESRD Network website and click the interactive map to locate network providers.
  • Call the National Cancer Institute (NCI) at (800)-422-6237 between 9 a.m.-4:30 p.m. Mon-Fri for help locating local cancer care providers. TTY: (800) 332-8615.

People on original Medicare can always see any doctor who accepts Medicare. Some rules may change in emergency or disaster areas depending on the situations, such as receiving covered services from a military provider.

The local ESRD Network (End Stage Renal Disease) can help with getting treatments and supplies, drugs, transport to treatments and emergency financial assistance

For Medicare Advantage or other Medicare insurance plans

Plans may make temporary changes to rules when health plan services get disrupted during an emergency or disaster. Check your plan’s website or contact your plan to find out what to do during an emergency. Generally, the plan allows for care from any Medicare provider even if that provider is outside the plan’s network. Prior authorization rules are usually waived during an emergency or disaster.

It is wise to keep the relevant telephone numbers in a safe place so they are available in case there is no way to look them up.

  • To receive dialysis treatments check with the plan to discover any temporary changes due to a disaster. Visit the ESRD Network website and click the interactive map to locate network providers.
  • For cancer treatments check with your plan for changes during emergencies or disasters.
  • Medicare can also provide plan contact information, call (800)-633-4227).

How to get prescriptions filled

Record the contact information for your drug plan and keep it in a safe place. In the event of a disaster the plan can help you:

  • Locate any pharmacy that can fill prescriptions
  • Locate in-network pharmacies that can fill the prescriptions
  • Get 60 to 90-day supplies of prescriptions

If you have to pay more for prescriptions than normal, you can make a claim with the Medicare drug plan for a refund. Save receipts!

How to get emergency replacements for medical equipment

To replace durable medical equipment (DME) that has been lost or damaged in a disaster, such as a wheelchair or walker, or supplies like diabetic supplies, contact:

  • Medicare at (800) 633-4227 if you have Original Medicare.
  • The Medicare Advantage or other Medicare health plan.

What to do if you miss the enrollment period

Medicare sets up special enrollment periods for people in areas hit by disasters. Call Medicare at (800) 633-4227 for the new enrollment period. The enrollment period applies to all plans.

Susan Polk Insurance Agency, Inc.

1443 Marsh St.

San Luis Obispo, CA 93401

(805) 544-6454

Press release is by San Luis Obispo SEO company Access Publishing, 806 9th Street, #2D, Paso Robles, CA 93446. (805) 226-9890.

Medicare plans San Luis Obispo

Medicare plans for San Luis Obispo county participants have a number of changes for 2018. The most significant of those changes are in the areas of premiums, deductibles, coinsurance payments and income brackets. Susan Polk Insurance Agency has summarized these changes and is announcing them to help Medicare recipients be aware of the changes and understand how they might be affected.

Medicare plan changes for 2018

Changes to Medicare for 2018 fall into four main areas:

  • Medicare premiums for Part A and Part B
  • Medicare deductibles
  • Coinsurance payments for hospital and skilled nursing stays
  • Income brackets

Along with these changes, the Medicare administration is mailing new Medicare cards starting in April. The new cards are automatically mailed to the address on record. Contact Social Security to update mailing addresses for the new card covering Medicare plans in San Luis Obispo County and elsewhere.

What you need to know about the new Medicare card

  • To protect identities the new card uses the Medicare number instead of the social security number.
  • Cards are not mailed at the same time so neighbors and friends will get them at different times.
  • Doctors and other healthcare providers are now able to look up Medicare numbers online but carry your new card with you to make it easier to provide the Medicare number.
  • The Medicare card is not an identification card. Only show it to doctors, pharmacists, health care providers, insurers or people you trust to work with Medicare on your behalf.
  • Additional instructions arrive with the card.

Medicare premiums

Participants who have been getting Part A hospital coverage as part of their Social Security Benefits without charge will continue to do so. Those who have been paying for Part A may see an increase between $5 to $9.

The Medicare Part B premium increases to $134 for most recipients. However, most recipients are protected by the hold-harmless provision so this increase will not reduce monthly social security payments.

Medicare deductibles

  • The Part A hospital annual deductible increases by $24 to $1340.
  • Part B remains the same at $183 annually.

Coinsurance payments for hospital and skilled nursing stays

Part A generally covers hospital stays after meeting the annual deductible and for stays up to 60 days. The following charges have increased for 2018:

  • $0 up to 60 days (no change)
  • $335 per day between 61 and 90 days (a $6 increase from 2017)
  • 91 days and more participants can use up to 60 lifetime reserve days but will need to pay $670 per day (a $12 increase from 2017)

There is no coinsurance charge for up to 20 days in a skilled nursing facility. For stays between 21-100 days, the charge is $167.50 per day. No coverage is available after day 100, forcing participants to cover costs or get payments from a supplemental Medicare policy. The agents at the Susan Polk Insurance Agency, specialists in Medicare Plans for San Luis Obispo County, can help people find the right plan to offset these gaps in Medicare coverage.

Income brackets

The Medicare Part B surcharges for those who make above certain incomes are remaining the same for 2018 but the income brackets have changed. The surcharge is an amount that is paid in addition to the base $134 per month that everyone pays, which increases Part B premiums for those with higher incomes.

The charges range from $187.50 for those with incomes between $85,000 and $107,000 to the highest $428.60 for incomes over 160,000.

Most of the income brackets were lowered in 2018. For example, the highest bracket for 2017 was income over $241,000. This highest earning amount was reduced to $160,000 for 2018.

Learning more about 2018 changes

Learn more about Medicare and changes for 2018 at the Medicare website. To learn more about how additional Medicare insurance plans can benefit you, contact Susan Polk Insurance Agency. The people at the Polk agency have been providing medical insurance since 1988 and specialize in Medicare insurance plans. They are always available to answer your questions and help you find the best affordable coverage.

Susan Polk Insurance Agency, Inc.

1443 Marsh St.

San Luis Obispo, CA 93401

(805) 544-6454

Press release is by San Luis Obispo SEO company Access Publishing, 806 9th Street, #2D, Paso Robles, CA 93446, (805) 226-9890.

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 www.susanpolk.com

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.    https://www.anthem.com/ca/health-insurance/home/overview  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.  https://www.blueshieldca.com/fap/app/search.html  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

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