Senior & Medicare Beneficary Resources
Have you heard you’ll be getting a new Medicare card? Wondering when or why? This isn’t happening until April 2018 but scammers are already jumping on the confusion as an opportunity for fraud.
Due to Congress’ passage of the Medicare Access and CHIP Re-authorization Act (MACRA) in 2015, the Centers for Medicare and Medicaid Services is require to remove Social Security numbers from all Medicare cards.
This change is to help prevent fraud and protect your identity. Currently, most people’s Social Security number is their Medicare number, which makes collecting Medicare numbers an easy target for scammers to steal your identity, open new credit cards or take out loans in our name. The new number, however, will not be tied to your Social Security number and is therefore more secure.
CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.
So how may scammers use this change to their advantage? Some scammers call beneficiaries claiming to be Medicare and say they must confirm their current Medicare numbers before sending them a new card. Others call saying there is a charge for the new card and are collecting b3eneficiaries’ personal information. There is no charge for your new card and Medicare will never call you for your information. They already have it.
If you receive any such calls or suspicious solicitations, hang up and call the Senior Medicare Patrol at 1-855-613-7080.
For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html
The Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research.
The Psychiatric Emergency Response Teams (PERT) consist of specially trained officers and deputies who are paired with licensed mental health professionals. Together, they respond on-scene to situations involving people who are experiencing a mental health related crisis and have come to the attention of law enforcement.
Hosted by the San Diego County Sheriff’s Department, the Take Me Home program is designed to minimize Law Enforcement response time and maximize search efforts to find a lost individual who cannot communicate. It includes but is not limited to persons with Autism, Dementia, Alzheimer’s, Down Syndrome, deafness or any other Developmental Disability.
Hosted by the San Diego County Sheriff’s Department, the You Are Not Alone Program is a free service for San Diego seniors who live alone and would benefit from a daily check on their welfare. The goal of YANA is to help enrollees feel safer while continuing to live independently.
On the Go is more than a ride—it’s independence, community connection, mobility, and dignity.
Seniors A Go Go reduces the number of missed appointments and helps older adults remain connected with their communities by providing transportation to essential locations. Contact ElderHelp of San Diego for more information and eligibility guidelines.
Does your Medicare Advantage plan include the SilverSneakers Fitness program? Ask us how to get it. The SilverSneakers network includes thousands of locally owned gyms and nationally recognized brands in fitness. You get access to a national network of 13,000 gyms and fitness centers with unlimited access.
Healthcare Reform & Industry Updates
A Federal Government Website managed by the U.S. Department of Health & Human Services. This is the best place to obtain more information on the Affordable Care Act (ACA), Covered California, enrollment and affordability FAQ’s.
The Henry J. Kaiser Family Foundation: Topics, perspective and regular newsroom updates.
On May 8th, I traveled to Sacramento where I joined my team of CAHU colleagues for our annual summit. We are all insurance agents providing products and services in the 31 flavors of health and life products, but most notably, we are consumer advocates standing up so every Californian will have access to private sector solutions for health, financial and retirement security.
In a nutshell the three day visit entails in depth review of legislation that can or will change health care law, speeches from CA State Senators that explain the complexities of the proposed bills, and government agencies that advise on consumer rights. Each day and all day, teams of three to four agents break from summit for 1:1 legislative meetings with Assembly Members and Senators to educate on the dribble down effect of how particular bills will hurt or help Californians and why they should be opposed or supported. Believe it or not, the persons holding those seats at the State Capitol will cast their vote for reasons other than your best interest.
I want to share this with you because I am greatly concerned about a new bill that was recently proposed in California – SB562 “The Healthy California Act”. Jointly Authored by: Senator Ricardo Lara (D), 33rd District. Senator Lara is running for Insurance Commissioner in 2018. Senator Toni Atkins (D), 39th District. Senator Atkins is former Assembly Speaker.
SB 562 states it would establish a state-run single-payer health care system providing comprehensive health care to every California resident. “Resident” is defined as an individual whose primary place of abode is in the state, without regard to the individual’s immigration status. On the cover it appears promising. In the context of the bill is the facts and truths that include a funding model that will crush the backbone of this state, the small business owner.
The single-payer universal health care plan will replace all employer sponsored benefit programs (union and non-union), the marketplace of private insurance policies, workers compensation, long term care, the Medicare program, and the Medi-Cal program. The state would work to obtain approval (via waivers) from Medicaid, Medicare, ACA and other federal programs to pay those federal funds and subsidies to the State of California.
All Californians will lose their current health plans, to be replaced by government run health care, with benefits yet to be determined, to be serviced by a government-run entity populated with political appointees yet to be identified, to include provisions yet to be named - all paid for by a doubling of your annual tax bill. This bill eliminates competition. Every provider in this state of California would receive the same reimbursement rate regardless of their quality of services. This provides zero incentive to improve quality or cost. This is not a Medicare for all health insurance policy with a robust provider network and a clearly defined covered list of services. This is Medi-Cal for all with limited access to care and ambiguous benefits.
SB 562 forces California to hand over at least $179 billion in new state taxes to pay for a government run health care system. This new $9,200 per person tax would be on top of every Californian's current tax bill.
Early cost estimates of a single payer measure reach as high as $350 billion in new taxes - a doubling of the annual state budget. At the Senate Health Committee hearing on April 26th, CalChamber Policy Advocate Karen Sarkissian quotes: “A payroll tax increase, such as the one needed to finance this bill, not only has a detrimental impact on businesses already in California; it also discourages companies from locating and establishing a business here. Just to cover the shortfall, the LAO estimated a tax of 16% on employers and employees would be needed, resulting in a multibillion-dollar tax increase on Californians.” My agency would be forced to close its doors with the implementation of these new taxes, and my family would be uprooted to relocate to another state.
Multiple state surveys performed this past April reflect that 80% of the population said they were “satisfied” with their coverage. With this kind of success, I vote to keep amending the Affordable Care Act to get that last 7% of the population insured, and NOT overturn all we have done that is right.
I believe that everyone should have access to affordable health care, and in California we are almost there. We are the most successful health care exchange in the country and have more choices in health care policies than almost any other state. Currently 93% of the state is enrolled in a health insurance plan and about 80% of those persons are covered through employer and union sponsored benefits. In the absence of benefit programs, employers and unions will lose their bargaining power and incentive programs for their employees and members and will shift those health care costs to the individual.
At a time when California has recovered somewhat from the Great Recession, and residents were just mandated to pay $69 billion in higher taxes for long-neglected education, water and transportation infrastructure repairs and upgrades, SB 562 will harm all of us with a limitless price tag and no guarantee of better health care for anyone.
This bill will move to appropriations and a hearing will commence on May 26th where it will most likely be tabled due to costs and probable opposition from our fiscally conservative Governor Jerry Brown. As his term is nearing its end and our next Governor is elected in 2018, this bill will come alive and be the hottest, most debated issue in California. Now is the time to understand what the future of SB562 means to you, your family, and your business.
I ask you to follow the facts, not the propaganda on social media. Write a letter or call your state legislation and be heard. Voice your concerns on quality of care, access to providers and new unnecessary taxes that would hurt you and your family.
✜ Single-payer abolishes private health insurance in California. Today, citizens know what their plan covers - and what it doesn’t. There are no specifics about what single-payer would cover, and those decisions are left to a government-run entity with political appointees.
✜ Single-payer mandates a government-run monopoly on all health care services in California. It eliminates private insurance, Medi-Cal, Medicare, Covered California, and the valuable advocacy services of insurance professionals and advisors.
✜ By eliminating employer paid health coverage, single-payer shifts health care costs to employees.
✜ Single-payer will increase your personal tax bill by almost $9,200 per person the first year it is in effect, and go higher each year. A $179 billion tax increase would essentially DOUBLE the size of the current state budget.
✜ A single-payer system like this makes California less attractive to doctors and health care providers. Our best providers would leave the state and we remain less attractive for new providers to practice in California.
✜ Single-payer puts 18% of California's workforce on the unemployment line. By giving Californians the highest state taxes in America, business will be forced to leave the state, making California a less attractive place to do business.
✜ While single-payer plans offer all citizens some kind of health care coverage, they cannot guarantee access to medical care.
✜ Single-payer inevitably control costs by rationing health care. Citizens in countries with single-payer models often wait months to see a doctor or specialist or to receive much-needed medical treatment. In some instances, citizens do not survive while waiting for care.
✜ Single-payer holds down costs by having one centralized government bureaucracy make all decisions with regard to health care services and prices. Single-payer means limited choices for consumers, discourages creativity, efficiency, quality, innovation and advancements in medical care.
✜ In government-run health care systems there is never enough money to provide timely care and the latest technology. That's because health care funds have to compete with other claims on government funds, such as education, welfare, water, and transportation infrastructure.
✜ Single-payer initiatives have failed in every state because the approach is not supported by most citizens. Californians want the legislature to focus on positive changes to reduce the cost of health care and health insurance in a public/private partnership.
AUDIO/VIDEO SENATE HEALTH COMMITTEE HEARING APRIIL 26, 2017: http://calchannel.granicus.com/MediaPlayer.php?view_id=7&clip_id=4456
CALCHAMBER POSITION ON SB562:
FOLLOW THE BILL SB562: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml
BILL TEXT: https://www.congress.gov/bill/115th-congress/house-bill/1628
|HR 1628 May 4, 2017 - Differences and similarities between the ACA and AHCA|
|ACA||AHCA (March 2017)||AHCA (May 2017)|
|Insurance mandates||Individual mandate and an income tax penalty for not having insurance||No individual or employer mandate|
|Employer mandate on larger companies||Insurers can impose a one-year 30% surcharge on consumers with a lapse in coverage of more than 63 days|
|Aid for premiums||Income-based subsidies for premiums that limit after-subsidy cost to a percent of income||Age-based refundable tax credits for premiums, phased out for higher incomes|
|Aid for out-of-pocket expenses||Tax credits for out-of-pocket expenses||No tax credits for out-of-pocket expenses|
|Annual limits on coinsurance, copays, and other costs|
|Medicaid||Matching federal funds to states for anyone who qualifies||Federal funds granted to states based on a capped, per-capita basis starting in 2020|
|Expanded eligibility to 138% of poverty level income||States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons|
|Lets state impose work requirements on Medicaid recipients|
|Premium age differences||Insurers can charge older customers up to three times as much as younger customers||Insurers can charge older customers up to five times as much as younger customers||Insurers can charge older customers up to five times as much as younger customers; states can apply for waivers exempting insurers from this limit|
|Health Savings Accounts||Individuals can put $3,400 and families can put $6,750 into a tax-free health savings account||Individuals can put $6,550 and families can put $13,100 into a tax-free health savings account|
|"Cadillac" tax||Cadillac tax on high-cost employer plans implemented in 2020||Cadillac tax on high-cost employer plans implemented in 2025|
|Other taxes||3.8% tax on investment income||Repeal of all four taxes|
|0.9% tax on individuals with an income higher than $200,000 or families with an income higher than $250,000|
|Fee on health insurance providers firms based on plans|
|2.3% tax on medical devices|
|Essential health benefits||Insurers are required to offer ten essential health benefits||Private plans are required to offer the ten essential health benefits.||States can apply for waivers exempting insurers from the essential health benefits requirement|
|Some Medicaid plans are not required to offer mental health and substance abuse benefits|
|Pre-existing conditions||Insurers are banned from denying coverage for pre-existing conditions||States are permitted to opt-out of mandating coverage for pre-existing conditions|
|Dependents staying on plan||Dependents can stay on health insurance plan until age 26|
Assembly Bill 72 was signed into law by Governor Brown on September 23, 2016. As of July 1, 2017, this new law will impose additional balance-billing prohibitions on “non-contracted” physicians beyond the current balance-billing prohibition for emergency services to patients covered by health care service plans.
The basic balance-billing prohibition imposed by the new law takes steps to ensure compliance. The law requires health plans and insurance companies to inform non-contracted physicians of the “in-network cost sharing amount” for which patients are responsible. The law establishes an independent dispute resolution process to determine the amount health plans and insurance companies must pay non-contracted physicians.
There are four essential elements for the application of the new law:
· A covered patient
· A contracted facility
· A non-contracted physician
· Covered services
If any one of these essential elements is missing, then the new balance-billing prohibition does not apply.
First, the patient must be covered by a health care service plan or an insurance policy. This could include Medicare managed care plans, but the new law expressly excludes Medi-Cal managed care. The law does not apply to self-funded “ERISA” plans. This can make things difficult, because it is not uncommon for payers such as Aetna or Anthem Blue Cross to administer self-funded plans as well, typically for the employees of larger employers. The fact that “Aetna” or “Anthem Blue Cross” is on the patient’s card does not definitively establish this first element.
The facility in which the services are provided must be contracted with the patient’s health plan or insurer. Facilities are generally limited to hospitals, surgery centers, primary care clinics, accredited outpatient settings where general anesthesia or deep sedation is administered, laboratories, and imaging centers.
The term “non-contracted individual health professional” includes medical professionals who are not contracted with the patient’s “health care service product.” The use of the word “product” suggests that IF you are not part of a payer’s narrow network, and IF the patient has chosen a narrow network product, then you will be deemed “non-contracted” under the new law.
The services rendered to the patient must be covered by the patient’s health care service product. If, for example, the patient’s health care service product does not cover general anesthesia for endoscopic procedures, then the covered service element would not apply for the endoscopic procedure.
Finally, the services rendered to the patient must not be “emergency services and care.” If the procedure is an emergency, then the new balance-billing prohibition would not apply. Keep in mind, however, that the current balance-billing prohibition can still apply for emergency services rendered to a patient covered by a health care service plan regardless of the setting.
When all four essential elements are present, the patient need pay no more than the “in-network cost sharing amount”. The patient should not be billed for this amount until the plan has informed the “non-contracting individual health professional of the in-network cost sharing amount owed” by the patient. This is the essence of the new balance-billing prohibition.
The Affordable Care Act, or health care law, contains benefits and responsibilities for employers. The size and structure of your workforce determines what applies to you. An employer’s size is determined by the number of its full-time employees, including full-time equivalents.
As a small-business owner, you may qualify for a federal tax credit to help offset the cost of providing health insurance to your employees by purchasing coverage with Covered California for Small Business. To qualify for a tax credit, employers must contribute at least 50 percent of their employee premium costs.
HR 360 New Law Exempts Certain Small Employer HRAs from ACA Market Reforms.
Allows small employers to offer new "qualified small employer health reimbursement arrangements" to reimburse employees for qualified medical expenses, including individual health insurance premiums.
Health and Wellness Resources
A great source for honest information to help you eat right, exercise, and do what's best for your body and mind.
You can join a FREE Healthy Living Class —In English or Spanish - designed just for you - to help you make positive, lasting changes in your life. During these sessions, Scripps experts will teach you about foods and exercise that protect against lifestyle-related diseases like Type 2 diabetes, Cancer and Heart Disease.