155 comments on “Blue Shield 65 Plus – Inspire HMO 2021”

1. Medicare Advantage plans must cover Medicare A & B https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services

   Reply

2. Steve,

   you have mentioned to me in my san mateo county, part c will be available to me with out any premium

   How about other neighboring counties like santa clara, alameda etc in bay area.

   How can I verify the same?

   I am thinking of moving to low cost counties.

   Reply

   • See our information and enrollment link above for Blue Shield

     Blue Cross

     Email us [email protected] for United Health Care, they don’t really let agents post anything.

     Watch the video we just made to guide you through the process. Blue Cross navigation would be very similar.

     Reply

3. tier one medication for ucla medical inspire hmo

   if there a charge for 90 days mail orders for my medicine

   zolpidem 5mg ,

   trazodone 50mg and

   lisinopril 2.5 mg ?

   what pharmacy will process orders?

   Reply

   • See the Blue Shield provider finder above to find participating pharmacies https://medicare.healthreformquotes.com/mapd/65-plus/#comment-25680

     Here’s a print pdf list of pharmacies

     You can also use Medicare’s tool to check Rx co pays https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/

     Blue Shield’s tool is in their enrollment portal https://medicare.healthreformquotes.com/mapd/65-plus/#enroll

     We’ll do more research, later in the day.

     What is your Zip Code???

     We can be your broker, no extra charge, if you use the enrollment link above or sign this form https://steveshorr.com/steveshorr/individual_and_family/blue.shield/Off%20Exchange%20IFP%20%26%20Med%20Supp%20POR%20Change%20Request%20Form.pdf

     Reply

4. I’ve heard that Blue Shield has PPO here in Santa Barbara can you send me the link or info for these?

   I never liked HMO.

   Reply

   • Please, we are not allow to go by hearsay – that is what someone told you. We only go by what is in writing.

     We’ve listed all of Blue Shield’s California Plans above. You can also go to Blue Shield’s website logo above, search & double check.

     Blue Shield Medi Gap Plans are PPO or even better as you can use ANY Medicare Provider! Blue Shield is having a UNDERWRITING HOLIDAY, so you can enroll now, without doing Health Questions https://medicare.healthreformquotes.com/medi-gap/blue-shield/#comment-25630 Use the logo above to get quotes or use the rate sheet above.

     We are NOT aware of any PPO MAPD plans in Santa Barbara. We even checked with Medicare.Gov https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/

     We’ve answered similar questions at

     Blue Shield’s HMO MAPD rate is zero vs UHC of $89/month – See above for Blue Shield details. UHC doesn’t allow agents to post anything meaningful. We can email you their information by request.
     https://medicare.healthreformquotes.com/mapd/uhc/#comment-25661

     If you would like to review the pros & cons in more detail, please set a Zoom meeting https://steveshorr.com/intro/set-a-meeting/ and sign & return a scope of appointment – permission slip https://steveshorr.com/steveshorr/medi_gap_medicare_advantage/aarp/2019/Scope%20of%20Appointment%20-%20pdf%20fillable%20Generic%20Form.pdf

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     • See our You Tube video explaining all this https://youtu.be/720-ovAfQF0

       Reply

       • Video Links to follow along

         Detailed answer to inquiry about Medicare Advantage PPO availability in Santa Barbara County.

         PPO Blue Shield?
         https://medicare.healthreformquotes.com/mapd/65-plus/#comment-25674

         Better plan than UHC AARP?
         https://medicare.healthreformquotes.com/mapd/uhc/#comment-25661

         Blue Shield Medi Gap Underwriting Holiday
         https://medicare.healthreformquotes.com/medi-gap/blue-shield/#comment-25630

         Blue Shield Medi Gap Plans
         https://medicare.healthreformquotes.com/medi-gap/blue-shield/

         Plans at a glance
         https://steveshorr.com/steveshorr/medi_gap_medicare_advantage/blue.shield/2021/2021%20Blue%20Shield%20Medicare%20Supplement%20-%20Health%20Plans%20at%20a%20Glance.pdf

         Summary of benefits Medi Gap
         https://contentserver.destinationrx.com/ContentServer/DRxProductContent/Medigap_PDFs/128_0/2021_Medicare%20Supplement_Summary%20of%20Benefits_EN%20v2.pdf#page=17

         Medi Gap Rate Sheet
         https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=2021_MedicareSupplement_OpenPlanRateSheets_EN.pdf#page=4

         Blue Shield MAPD California
         https://medicare.healthreformquotes.com/mapd/65-plus/

         Blue Shield Print Directories
         https://medicare.healthreformquotes.com/mapd/65-plus/provider-directories/

         Blue Cross PPO Orange County
         https://medicare.healthreformquotes.com/mapd/anthem-mediblue-plus/

         Blue Cross Evidence of Coverage
         https://file.anthem.com/MED2021/Y0114_21_123039_U_C_0315.pdf

         Blue Cross Summary of Benefits
         https://steveshorr.com/steveshorr/medi_gap_medicare_advantage/Anthem/MAPD/2021/Y0114_21_123777_U_M_0065_H8552_020-000_CA_LPPO.pdf

         Set a Zoom meeting
         https://steveshorr.com/intro/set-a-meeting/

         UCLA accepted plans
         https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=2021_MedicareSupplement_OpenPlanRateSheets_EN.pdf#page=4

         How to use Medicare Shop & Compare tools – Don’t buy there – come back to us to enroll
         https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/

         Costs to provide health services
         https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet

         Online Seminar
         https://medicare.healthreformquotes.com/seminar/

         Reply

5. FAQ’s from prior webpage

    

   1. Where do I find a list of providers that are endodonic dentists in or near fullerton ca 92835 and accept the blue shield 65 plus choice co pay listed in the 2016 benefits listing
      • This seems to be a frequently asked question. I’ll answer it on this new page.
   2. Hi Steve,

       

      I Just got off the phone with the Social Security Dept. as I needed clarification on some of the questions asked in the online application for Medicare.

      This woman “Tracy” states that I am not eligible as I don’t have enough credits and won’t be eligible until Bruce turns 62 this coming October, then apply under him as he does have the credits.

      She told me that I wouldn’t be able to apply until open enrollment, Jan-March 2017.

      This seems odd to me but need your take on this.

      Thanks,

      Jackie

      • This is an interesting question as it’s the first time it’s come up for me for someone who has lived in the USA all their life. The answer is simply to pay for Part A $426, click here for more detail and reasoning.
   3. What is the deadline to enroll when someone ages into Medicare, age 65?
      • The Initial Enrollment Period for someone turning 65 to sign up for Medicare A Hospital B Doctor Visits and for a Medicare Advantage Plan is 3 months before you turn 65 and 3 months after the month that you turn 65. Learn More Medicare & You 2016 Page 25 ======== Medicare Publication 11219 Page 3 Thus someone turning 65 last December has till the end of March to complete a MAPD Application and get coverage for April 1st
   4. How soon can Jackie enroll and when will her Medicare coverage under this plan begin? Our monthly premium for March under our current Health Net HMO plan is due March 10th (I think). If Jackie enrolls and coverage under this plan begins before April 1st will the premiums for the two plans be pro-rated?
      • She can enroll 24/7 by using my Blue Shield Agent affiliate link above. Her coverage will begin April 1st. Coverage won’t start till then, so, just pay Health Net for March and this premium for April. I’m surprised that Health Net hasn’t dropped her….
   5. Is there any supplemental coverage (which I think is referred to as “gap” coverage) available for prescription drug expense which is not paid by this plan? If so, what does it cost per month and what does it cover? Jackie takes Uloric 40 mg and it is expensive.
      • No! In fact it’s illegal to sell extra coverage. I don’t find the Blue Shield formulary handy. Did you want me to request it from Blue Shield Agent Support? The Medicare.Gov shop & compare tool shows the cost of Ulric 40 mg 30 pills/month to be $2,800 without insurance. It appears from the tool that Ulric is available mail order and would be $240/year. I double checked this on the Blue Shield Affiliate Enrollment and Information site and they show $480. This might be that I picked the wrong pharmacy on the Medicare Site.
   6. Is this a Medicare Plan C which includes outpatient, inpatient and prescription drug coverage provided on an HMO basis by Beaver Medical Group (where Jackie and I currently have an HMO plan through Health Net)? What is the monthly cost if Jackie enrolls in this plan?
      • Here’s our Health Net page… Note that it doesn’t have a lot of information (CMS rules and all) and one just basically clicks through and then to enroll, just put in our agent code L 981. Here’s HN’s provider search. Beaver is on the Seniority Plus Sapphire Plan and the Seniority Plus Green Plan. The Sapphire Plan though has a $31 premium. It might be a plan for those on Medi-Cal & Medicare. Although, it’s not a requirement. Note the extra benefits, like transportation. Did you want me to double check?
   7. I am starting anthem mediblue select.
      A yearly dental cleaning and exam is included. How do I get the list of in network dentists in Riverside County, CA?
      • Someone just asked that exact same question yesterday. I responded on the dental page.
   8. what is the difference in blue shield 65+ and blue shield 65+ choice medicare advantage plans? we now have the regular 65+ we live in huntington beach ca (orange county) 92649 thank you

       

      thank youJoan V

      • Thank you very much for asking your question in the comments section of our website. It allows more people to learn the answers and get general information. The Plus Plan is offered in Orange County and Portions of Los Angeles County. To see if your MD’s are on the list, use the search feature, check this directory or call your MD’s. The choice plan has slightly better benefits. Here’s a side by side comparison.

   Reply

6. Any notions about when the 2021 Medicare Advantage details and provider lists might be available?

   Thanks for a very informative website.

   Sorry that my PCP doesn’t take the Blue insurance so I could give you some business.

   Reply

   • Plan information will be available October 1st and you can enroll or change plans October 15th. CMS.gov

     We represent not only Blue Shield, but UHP and Blue Cross. What is your PCP’s name and we can check those provider finders:

     https://www.blueshieldca.com/fad/home

     https://www.anthem.com/ca/find-doctor/?dplid=sso.dpl.providerdirectory.search-criteria

     https://connect.werally.com/county-plan-selection/uhc.mnr/zip

     Reply

7. I am signing up for medicare this month and want to know about doctors, in particular, urologists and GI doctors, in the Blue Shield Inspire Network.

   My family doc is already in this network.

   I live in the Redondo Beach/Torrance, CA 90277 area.

   Reply

   • Here’s the Blue Shield Provider Finder

     We found 67 doctors with 10 miles for urology and gastroenterology. The list has been emailed to you.

     What medical group is your family doctor in. You’ll want the specialist to be in the same group.

     See page 40 of the Inspire Evidence of Coverage for how referrals to specialist work in the same network – group.

     We have print directories on this page

     Here’s how to enroll in Inspire. No extra charge for our website and our help.

     Here’s instructions and the link to enroll in Medicare A Hospital and B Doctor Visits

     Reply

8. I have Blue Shield 65 Plus (HMO), Santa Barbara County, CA …

   is it possible to get PPO?

   Reply

   • Blue Shield doesn’t have a Medicare Advantage PPO that I’m aware of.
     Blue Cross does, but it’s only in Orange County.

     At Open Enrollment you can qualify for a Medi Gap plan if “any” of the benefits change. Blue Shield at all the Broker meetings state they will do this for anyone, on a MAPD plan, but I really like to have something in writing before I say it.

     There is also a MA OEP Open Enrollment Period – the name gets confusing as Open Enrollment is now called AEP – Annual Election Period. The dates of this MA OEP is January 1 to March 31. Agents are not allowed to promote this. We can only tell you if you ask, which you did.

     Are you in your first year of a Medicare Advantage Plan? There is a one year “test drive” aka trial period.

     Please send us your zip code and we can check the Medicare Plan Finder and see if there are any PPO’s that we are not readily familiar with.

     What is it that your looking for, that the plan you have isn’t keeping you 100% happy?

     Do you have a chronic illness? There may be plans that better fit your needs? SNP Special Needs Plans.

     Have you used the Blue Shield provider finder above? Can you find a provider there that will make you happy?

     One problem with a MAPD PPO, is that there is still a doctor list and you’ll want to look at the coverage if you go out of network. It’s not that terrific. Also, the premium is $159/month.

     

     Reply

     • If you would like to discuss further, via phone, skype, face time, etc., click here to set a time.

       Reply

9. On your Inspire program, what are considered “over-the-counter” items?

   Does it include vitamins?

   Reply

   • Click here for orders and to view catalog

     Yes, Vitamins & Minerals are included

     Page 83 of evidence of coverage

     Reply

     • Do you have to have a doctors note to buy the vitamins?

       Reply

       • No. I don’t find a definition in the EOC, thus let’s go by the FDA’s definition:

         Over-the-counter medicine is also known as OTC or nonprescription medicine. All these terms refer to medicine that you can buy without a prescription. They are safe and effective when you follow the directions on the label and as directed by your health care professional.

         Just follow the links above to view the catalog and to place your order.

         To enroll and have us as your agent, no extra charge, click on the links in the body of the webpage above.

         Reply

     • I’m enrolled in BlueShield +65 HMO in San Luis Obispo.

       Where can I find the on-line catalog for over-the-counter meds, supplements, etc?

       And how do I place an order?

       I can’t find any info on-line about the benefit.

       Reply

       • Isn’t our website the greatest thing since sliced bread? We’ve already answered your question above. One just has to go through the Q & A.

         How about appointing us as your agent, no extra charge whenever you might make a change to your program?

         Reply

10. How do I enroll in Inspire or any other Blue Shield MAPD?

    Reply

    • Online with our Blue Shield Affliate Link – No extra charge for agent support

      Paper Application

      Transfer Application if you already have a Blue Shield Plan

      We can help you via Phone, Skype or Face to Face

      See our scheduling calendar below to set a meeting.

      Reply

11. Please explain Blue Shield inspire 2020 to me.

    I had Medicare Supplement Blue Shield extra F Plan 2019,

    My doctors all in UCLA Medical Group. Next year UCLA accept Blue Shield Inspire HMO.

    Shall I change to HMO from Medicare Supplement?

    Reply

    • I’m not sure what you mean by explain Inspire 2020 to you? Here’s the Summary of Benefits for Los Angeles & Orange County. Did you have a more specific question?

      Here’s the summary of benefits for Plan F Extra Medi Gap – Our webpage on Plan F Extra

      Yes, UCLA will accept Inspire in 2020.

      The difference between HMO Medicare Advantage and Medicare Supplement is, I’m not sure of the right word, but it’s the main decision to make, once one has Medicare Parts A & B. Here’s our webpage on which way to go.

      If you decide to remain on your Medi Gap plan, here’s the form to appoint us as your agent, no extra charge and allows us to get paid for helping you.

      Official Medicare Video on understanding your choices

      Reply

      • If I want to switch back to the Medi Gap plan in 2021, can I do that?

        Reply

        • Let me review Blue Shield Guaranteed Acceptance Guide

          https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=MSP17149.pdf and get back to you tomorrow.

          Reply

          • These “situations” might allow that

            # 17 You enrolled in a Medicare Advantage Plan and that plan either:

            • Reduced any of its benefits;
            • Increased the amount of cost-sharing or premium; or;
            • Discontinued (for other than quality of care) a contract with a provider currently furnishing services to you.

            # 9

            You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:

            • A Medicare Advantage Plan
            • A Medicare Cost Plan or similar organization operating under demonstration project authority before April 1, 1999;
            • A PACE provider; or
            • A Medicare Select policy.

            You then disenrolled within the first 12 months.

            Reply

    • Why do I need blue shield Medicare Advantage with medicare A & B?

      It’s a nightmare to see doctors and get the necessary treatment while my friend has only medicare A & B and can go to any doctor

      Reply

      • Medicare A Hospital & B Doctor visits, pay a lot, but not everything.

        It doesn’t pay for out of hospital Rx Drugs. If you don’t have a Medicare Advantage Plan, you can get Part D Rx separately.

        See the video above about your Medicare Choices.

        The Inspire Summary of Benefits – shows that you pay NO EXTRA premium for the plan! It also shows, what you pay for various services. What it doesn’t show… is what you would pay, if you didn’t have a plan. See the screen shot’s below. The first is the MAPD inspire plan. The 2nd is a Medi Gap plan, which does have a premium and then you will also need a Part D Rx plan.

        

        Blue Shield Medi Gap Summary of Benefits

        Hosptial
        

        Part B
        

        Foreign Travel
        

        Reply

      • Please explain “Nightmare?” Here’s the provider finder

        Here’s the procedure to make a complaint in the Evidence of Coverage for Inspire.

        So, the choices are,

        pay for a separate Part D plan,

        premium for a Medi Gap plan that allows you to see ANY Medicare MD and will even pay the part that Medicare doesn’t if your MD charges more – see details in the evidence of coverage or our assignment page.

        or pay out of pocket what Medicare doesn’t pay… don’t forget the 80% never ends. There is NO OOP Out of Pocket Maximum

        Reply

12. How can I find a list of participating doctors & hospitals?

    Reply

    • Scroll up the page and use our Provider Finder

      Check this page for pdf print directories

      Click on Blue Shield link above to enroll in a plan. No extra charge for our services. Blue Shield pays us to help you enroll.

      Reply

      • What do I have to do to see a specialist?

        Reply

        • I’ve cut and pasted this from the Evidence of Coverage

          Section 2.2 What kinds of medical care can you get without getting approval in advance from your PCP?

          You can get the services listed below without getting approval in advance from your PCP.

           Routine women’s health care, which includes breast exams, screening mammograms (xrays of the breast), Pap tests, and pelvic exams as long as you get them from a network provider.

           Flu shots, Hepatitis B vaccinations, and pneumonia vaccinations as long as you get them from a network provider.  Emergency services from network providers or from out-of-network providers.

           Urgently needed services from network providers or from out-of-network providers when network providers are temporarily unavailable or inaccessible (e.g., when you are temporarily outside of the plan’s service area).

           Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area. (If possible, please call Member Services before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away. Phone numbers for Member Services are printed on the back cover of this booklet.)

          Section 2.3 How to get care from specialists and other network providers

          A specialist is a doctor who provides health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:

           Oncologists care for patients with cancer.

           Cardiologists care for patients with heart conditions.

           Orthopedists care for patients with certain bone, joint, or muscle conditions.

          When your PCP thinks that you need specialized treatment, they will request a referral (approval in advance) to see a plan specialist or certain other providers. For some types of referrals, your PCP may need to get approval in advance from our plan (this is called getting “prior authorization”). For more information about which services require prior authorization, see Chapter 4, Section 2.1 of this booklet.

          It is very important to get a referral (approval in advance) from your PCP before you see a plan specialist or certain other providers (there are a few exceptions, including routine women’s health care that we explain later in this section). If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself.

          If the specialist wants you to come back for more care, check first to be sure that the referral (approval in advance) you got from your PCP for the first visit covers more visits to the specialist.

          When you choose your PCP, you are also choosing the hospital and specialty network associated with your PCP.

          If there are specific specialists you want to use, find out whether your PCP sends patients to these specialists. Each network PCP has certain plan specialists they use for referrals. This means that the PCP you select may determine the specialists you may see. You may generally change your PCP at any time if you want to see a plan specialist that your current PCP can’t refer you to. Earlier in this chapter, in Section 2.1 under “Changing your PCP”, we tell you how to change your PCP. If there are specific hospitals you want to use, you must first find out whether your PCP uses these hospitals. Note that changing your PCP may result in being limited to specific specialists or hospitals to which that PCP refers (i.e., sub-networks, referral circles).

          Reply

          • What if my PCP won’t give me a referral?

            Reply

            • See Chapter 9 of EOC about if you have a problem

              See our webpage on appeals & grievances

              Our webpage on IMR Independent Medical Review

              Reply

13. I live in Orange County and have Blue Shield 65 Plus.

    I got an outpatient X-ray done at my doctor’s, St Jude Heritage.

    On my summary of benefits
    https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=2019_MAPD-LAOR-SOB.pdf

    it clearly states that I pay nothing.

    However, Blue Shield is telling me that because my doctor ordered 2 views it now becomes a “complex X-ray” to quote them and therefore I have to pay a $40 co-pay as if it was a ct scan etc,

    What is going on?

    Reply

    • Sorry, your question is beyond my pay grade. Here’s the answer, but I don’t understand nor have say 10 hours to review the material to answer the question for you. Somehow you’ve gone over a basic test and into the realm of radiology services.

      Medicare Learning Network
      Medicare Claims Processing Manual Radiology Services
      United Health Care MAPD Manual
      https://www.medicare.gov/coverage/x-rays
      Image is from the Evidence-of-Coverage above.
      

      Reply

14. Does blue shield 65 plus 2019 cover any chiropractor care as basic medicare does?

    Reply

    • We gone into that pretty thoroughly on this page. See exhibits 13 & 14 on that page. If you have further questions, please post in the ask a question section on that page.

      Click here to enroll in Blue Shield for 2019. No extra charge for our help.

      Reply

    • How do I find a Chiropractor for the Inspire Plan?

      Reply

      • call ASH American Specialty Health Network customer service at (800) 678-9133

        Verified with Blue Shield reference number 200270024298

        Reply

15. My doctor doesn’t take any HMO’s. What else might I look at?

    Reply

    • Here’s some thoughts & suggestions:

      Medicare Advantage offers Part D Rx at no additional charge

      You might just pay cash for the entire MD visit, Medicare wouldn’t pay, as when you have Medicare Advantage, the Insurance Company takes care of everything.

      See our webpage on the pros & cons of Medi Gap vs Medicare Advantage and what’s best for each person.

      Just get a Part D plan and leave what Medicare doesn’t pay as something you pay out of pocket, like you’re doing now. Note, if you didn’t buy Part D when first eligible, there might be a late enrollment penalty.

      Get a Medi Gap plan. Look at High F from Blue Shield, sure it has a deductible, but that doesn’t stop Medicare from paying first. The price is right. Here’s where we explained to another web visitor how to figure out the rate chart. Or, just send an email, with zip code and date of birth and we can send you your specific rate.

      If you want to discuss this on the phone, face to face, video conference, etc. see above for our appointment scheduler.

      Reply

16. I moved from Orange County to Redlands in San Bernardino County. Since there is a change in residency, I have to change plans and have a special enrollment period to do so.

    My question is, can I keep my same MD:

    Norman J Rosen M.D. 2501 Chapman Ave, Orange, CA

    Reply

    • IMHO the simplest is to call your MD and ask. However, CMS rules require that an agent call the Insurance Company or check the provider directory. ONLINE is best, as the printed directories get outdated quickly.

      Here’s the Blue Shield provider directory. It’s also listed above. Here’s more detail and instruction on how to use the Blue Shield provider search.

      We do find Dr. Rosen listed, see below. There is a rule somewhere about a doctor having to be within 20 miles. Let me check that.

      Reply

      • Here’s a screen shot showing the Dr. Rosen is listed. The Plus plan has more MD’s than the choice plan, so that stands to reason

        Reply

      • The rules for picking a provider start on page 40 of the Evidence of Coverage. I don’t see any rule about 20 miles… However, the print edition of the San Bernardino doctor list for 2017 doesn’t show Dr. Rosen. So it may be that he’s not a provider for San Bernardino County. Let me check further.

        If you click enrollment links above, we can do the transfer for you and thus get paid for helping you.

        Reply

      • Here’s a rule about 30 minutes or 15 miles:

        Primary care network providers within 30 minutes or 15 miles of each covered person’s residence or workplace. insurance.ca.gov

        If you really want Dr. Rosen, you do have a guaranteed right to get a Medi Gap plan. We can help you with that.

        Reply

        • Can I file an appeal based on continuity of service?

          He’s treating an ongoing problem

          Reply

          • Review our page on continuity of care SB 133. Double check if it applies to MAPD. Even if it doesn’t specifically, there must be similar legislation for MAPD plans.

            Review the appeals procedures in the evidence of coverage.

            Review the appeals procedure on our website.

            When you appoint us as your broker, no charge, we can help you with this.

            Reply

            • If the appeal fails, what if I just go outside of the Insurance and pay cash?

              What is my deadline to change plans after a move?

              Reply

              • Right, you would have to pay cash, as the Insurance since you have a MAPD plan would not pay anything. Medicare would not pay, as they are paying your MAPD plan to take care of you. You basically trade in your Medicare Card for a MAPD plan. There are certain times that you can get out of an MAPD plan and get regular Medicare. You would also have an enrollment period into a Part D Rx plan.

                It’s Sunday. Give me a few days to research. Of course, the best place to look is probably your evidence of coverage page 48 cited above.

                Reply

              • Deadline to change plans after a move. Check our residency page and the evidence of coverage Page 8, 181, 244, 246, Service Area definition page 263, special enrollment 263, , .

                Reply

              • If you drop the MAPD plan because of the move, you can do that now. You wouldn’t have to wait till MAPD open enrollment. At 2019 open enrollment you could select a new MAPD plan. As we said above, you can get a Medi Gap plan now, to pay what Medicare doesn’t pay. You can also get an Rx plan now, during special enrollment.

                Reply