Margy Wenham Insurance Services, Inc - Serving California Since 1991

California has just completed another successful open enrollment season and the percentages of those who are uninsured have dropped to 7.1% - a record low in our state. As a health insurance professional in California, I understand the importance of quality health care coverage and affordability of that coverage.  That is why I'm compelled to write this blog entry. The California Senate is presently seeking to abolish private health insurance in California, along MediCal, Medicare, Covered California, and the valuable advocacy services of health insurance professionals.  Under Senate Bill (SB) 562 ALL Californians will lose their current benefit plans, to be replaced by benefits yet to be determined, to be serviced by an entity yet to be identified, to include new tax provisions yet to be detailed.  This would be disastrous for all Californias.  A bill of this magnitude has too many unanswered questions and Californians cannot afford "to pass it to find out wha...

Because of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, Medicare Supplement Plan F will no longer be sold starting in 2020.  Congress decided to do away with plans that fully cover all deductibles.  Plan F (presently the most popular plan sold) covers all of Medicare’s deductibles and co-pays. The elimination of Plans F (and C) are thought to decrease claims and ease the financial strain on Medicare. The theory is that if a Medicare recipient doesn’t have to pay anything for a doctor visit, they’ll see a doctor more frequently.  On the contrary, if Medicare recipients become more responsible for their out-of-pocket medical expenses they’ll see their doctor less. While Medicare’s actual cost-savings from this change can’t be calculated, it is “projected” to save billions each year.  If You Have Plan F Prior to January 1, 2020 You Can Keep It Indefinitely If you have Plan F when January 1, 2020 comes around you don’t have to do anything...

When choosing a Medicare Part D Drug Plan (usually during the annual Open Enrollment Period and between October 15th – December 7th) most do so based on their current medications.  Frequently, however, over the course of the plan year medications are added or dropped.  Consequently, a plan that once covered each of your medications may not later.  Are you then stuck until the next Open Enrollment Period?  Not necessary.  Initially, the simplest approach may be to ask your doctor to prescribe another medication. Talk to Your Provider Often, there are many medications that achieve the same objective of your physician.  If a drug isn’t covered ask your doctor for an alternative medication.  If there isn’t an alternative drug available, then consider seeking a “drug formulary exception.” Formulary Exceptions and Plan Determination Requests An enrollee through his doctor can request a drug plan formulary exception to cover a medication. These exce...