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As we move into renewal season, [11.1.2016 – 1.31.2017]  I have a couple of questions.  There is a change in health circumstances and we both will turn 65 during 2017 (Susan in August, me in October).  The health circumstance is that I have been diagnosed with and am about to begin treatment for [redacted].  It is supposed to be readily treatable, so I expect (hope) to have a long life after treatment.

***We hope so too.   Your coverage is here to keep you financially strong to.  Medical bankruptcy affects too many people in the USA.

I have maxed out my copay [OOP Out of Pocket Maximum] for the year, so the rest of the year is “free.”  The treatment will continue into the first couple of months of 2017, and I guess I will be having periodic checkups thereafter.  This is a long way of saying that I am glad that we got a Platinum level plan and assume we should continue it next year.  So my questions are:

Do you agree that Platinum is the way to go,

***Here’s worksheets with sample claim scenarios  for sample claims at each metal level.  Probably Platinum would work best for you.  It is possible to have platinum for you and silver for your wife.  You might also look at Bronze with an HSA – Health Savings Account.

and if so what are the costs for CA BS Platinum for next year?

***PPO benefits and rates on pdf, NOT computerized are on this page.   Trio Aco HMO here.   We suggest that you just wait till 11.1.2016 and get quotes here.  If your MAGI income has dropped, the quotes will include the tax credits.

How does turning 65 factor into this,

***Medicare, if you sign up during the guaranteed issue period for Medi Gap,  or MAPD does not have any pre-x clauses!  When might you reach your Out of Pocket Maximum on the under 65 plan?  Certainly, platinum has lower deductibles and co pays.

and when do we need to start deciding things with Medicare?

***Three months before you turn 65.  I suggest though that you start reviewing the Medicare & You manual now.  Here’s how chemotherapy is coverage – Page 41 of Medicare & You 2017  *

  Does the individual plan terminate at age 65,

***We will need to request the policy be terminated.   New people though can’t buy an under 65 plan if they have medicare.

continue through the rest of the calendar year, or what?

***You could keep your current plan, but Medicare pays first.

Learn More  ===>  Dual Coverage  *  Specimen Policy page 112

I never got around to resolving the issue about whether we did or did not want the vision care that we have been paying for in 2016.  Can you clarify what the costs are and what the benefits are for 2017?

***See page 7 of the rate chart in pdf    Check these pages for Dental & Vision

Blue Shield Dental (& Vision)




Mike F

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