Stephanie Frisch

Stephanie Frisch

Stephanie Frisch is the owner of Insurance 101 and is an independent insurance broker dedicated to helping others make “educated decisions” about their insurance choices when it comes to Medicare, Long-Term Care Planning, The Health Insurance Marketplace-Covered California and Life Insurance. For answers to your questions, or an in-home, no-fee consultation, call (949) 351-2443.

Most people I meet have the wrong impression of what a Medicare Advantage plan network is.  Once they hear “HMO” they visualize a network that controls the doctor’s ability to act independently and no access to the best hospitals in Orange County.

The networks that participate in Medicare Advantage plans are an association of physicians in private practice along with hospitals, labs and urgent care centers. These types of networks, even though they are referred to as an “HMO” are very different from the Kaiser/HMO structure.

First, let’s define what a “Network” is.

Medicare Advantage plan networks deal with independent, private-practice physicians that are part of a coordinated network that works together to promote excellence in patient care. There are some really big networks here in Orange County. Most people that live in South Orange County would want to go to the Hoag, Mission, Saddleback, or UCI hospitals. All of these hospitals participate in Medicare Advantage plan networks. When I sit down with someone who is activating their Medicare Part B option for the first time (such as turning 65 or retiring) or looking to enroll in an Advantage plan during the annual enrollment period in the Fall, the first thing I ask is who their primary care physician and specialists are. The majority of the time their physicians are already participating in Medicare Advantage plan networks. (Such as Monarch, MemorialCare , Greater Newport Physicians, the most recently formed network; St. Joseph Hoag Health...just to name a few).

Some are concerned that their doctors will be upset if they go to a Medicare Advantage plan, as if they will be “cheating” their doctor out of something. That is simply not the case. To quote one of the doctors that I work with, “As it turns out, the Medicare HMO capitation is often better for the physician than the fee for service reimbursement”.....Capitation means the doctor gets paid MONTHLY when you enroll in a Medicare Advantage plan and have them listed as your primary care physician. They get paid whether they see you or not! If you use Original Medicare (with or without a Medicare Supplemental plan), they ONLY get paid when they see you! So for most doctors, a balanced “book of business (patients)” makes a lot of sense for them economically.

If you are turning 65 or retiring anytime in the near future, please call to schedule a no-fee consultation, it costs you NOTHING to enroll in your Medicare plan using my services. You’ll see why hundreds of people faced with the same decision as you feel relieved and happy that they took the time to meet with me.

For many, a new year means a commitment to their health.  It’s important to be current on what your Medicare benefits cover and the current screening schedules for routine testing.

During the first 12 months of activating their Medicare Part B, new Medicare beneficiaries should utilize their “Welcome to Medicare” preventative visit with their doctor.

This visit includes your doctor reviewing your medical and social history related to your health and includes certain screenings, shots, and referrals for other care, if needed. It includes height, weight, and your BMI calculation. Also included are blood pressure measurements, a simple vision test, and a depression screening. A recent addition to this visit is a consultation on creating an advanced directive. The doctor should then give you a written plan letting you know which screenings, shots, and other preventive services you need.

If you’ve had Part B for longer than 12 months, you can get an annual wellness visit.

Annual wellness visits are to develop or update a personalized prevention plan based on your current health and risk factors. This visit is covered once every 12 months.

IMPORTANT! This visit doesn’t include lab tests, or any DIAGNOSTIC testing. You may be responsible for payment for lab or diagnostic testing performed during your visit. It is important for you to visit www.Medicare.gov to see when certain screenings are covered by Medicare at zero cost to you otherwise you may be paying for many of these “routine” tests out of your own pocket. These common tests have a rotation varying from every 12 to 60 months. For example; Breast Cancer Screenings- 12 months; Cardiovascular Disease Testing- 60 months; Cervical and Vaginal Cancer Screening- 24 months; Prostate Cancer Screening Exams- 12 months.

With Open Enrollment behind us, many Medicare beneficiaries that are on a Medicare Advantage plan are unaware of the annual Medicare Advantage Disenrollment Period.

From January 1st to February 14th beneficiaries who wish to dis-enroll from their Medicare Advantage plan and go back to Original Medicare are allowed to. They can purchase a Medicare prescription drug plan and a Medicare supplemental plan to round out their Medicare coverage and fully protect themselves. Adding the Medicare prescription drug plan is a guaranteed right for them, but enrollment in a Medicare supplemental plan is not guaranteed unless certain criteria is met.If an individual does not meet the guaranteed issue criteria, then underwriting is involved. Sometimes someone doesn’t qualify right away for a Medicare Supplemental plan, and they may need to wait to add it until they do. Once someone is on Original Medicare, a supplemental plan can be added anytime in the year. Most people I meet with are unaware of this.

The second important enrollment period is the Medicare General Enrollment Period and it occurs annually between January 1st and March 31st, with coverage starting July 1st.

This is an important window of time for those that didn’t activate their Part B portion of Medicare during their Initial Enrollment Period, or had Part B activated but then dropped it. The first of the two scenarios is happening more frequently as the age requirement for receiving Social Security increases. Many people are still under the impression that they are automatically enrolled in Medicare Parts A and B when they turn 65. But now that most don’t qualify until after turning 65 for Social Security, they need to go online to Medicare.gov to enroll in Part B three months prior to their 65th birthday month. (Enrollment in Part A still happens automatically at 65 and for the majority of the population, and has no premium.) The second scenario; dropping Part B during the year generally happens because someone forgets to pay their premium (If you aren’t taking Social Security you get billed quarterly for Part B), or they fall on hard times and choose to not pay it.

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

Now into its third season, the Affordable Care Act has changed the lives of millions. California leads the way as the most successful state run exchange for those applying through Covered California. Here are my Top 10 Reasons why I think ACA Health plans are better;

  1. No one can be declined or charged more for health conditions.
  2. Women pay the same premium as men do at any given age and vice versa.
  3. The out of pocket maximum now INCLUDES doctor visits and prescription drug co-pays.
  4. Preventative healthcare and immunizations are now covered 100% with no co-pays.
  5. You can purchase a zero deductible plan AND have a low out of pocket maximum as well.
  6. There is no limit to the amount of physical therapy visits in a year.
  7. Pediatric dental and vision are now included in all plans for children up to age 19.
  8. Acupuncture is now covered.
  9. There are no plans offered by insurance companies that have “gaps” in coverage anymore.
  10. Federal subsidies have helped thousands of people here in Orange County, if you’re reading this right now, more than likely, whether you know it or not, someone you know or love has felt a burden lifted by the assistance they’re receiving.

If you don’t have health insurance in 2016, you’ll pay the higher of these two amounts: 2.5% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.)

The maximum penalty is the national average premium for a Bronze plan. Or, you’ll pay $695 per person ($347.50 per child under 18). The maximum penalty per family using this method is $2,085. Bottom line is it’s a lot of money and your risking even greater financial loss, and possibly ruin by going uninsured.

I know it can seem daunting, but for someone into their third year handling Covered California it’s really not. That’s why getting FREE help from me makes so much more sense than just putting your head in the sand and hoping it goes away, because it’s looking like the current process is here to stay.

Generally someone only applies for insurance through Covered California if their income is close to the guidelines below. You have to estimate your income for the upcoming year, so if you aren’t sure what it will be exactly, applying through Covered California will ensure that you DO get the Federal subsidy money that you deserve at tax filing time if you estimated making more money than you actually did.

If your income is under $47K as an individual, $63K as a married couple or $97K as a family of four (for example, not limited to) you have options with Covered California. You have until 1/31/16 to enroll in a plan for 2016 to avoid the penalty for 2016. If your income is higher, then we apply directly to the insurance plans for coverage. For coverage to start January 1st you need to apply by 12/15/15. If you’d like assistance understanding your choices, call to schedule a phone consultation with me, once again, my services are free.

Medicare beneficiaries, are your mailboxes and recycling bins ready? Yes, pretty soon literature from the various insurance companies will start the annual flow of information to you.

ctober 1st is the first day that the insurance companies and their representatives can begin telling you about what their Medicare Advantage and Medicare Prescription Drug plans will be offering for 2016. October 15 through December 7th is the timeframe that you have to enroll in one of these plans, or change the plan that you currently have.

First off, if you’re on a Medicare Supplemental plan (sometimes called Medigap), such as Plan F or Plan N, you can relax. These plans don’t change their benefits annually like Medicare Advantage and Medicare RX plans do. However, if you’re on one of these plans and you’d like to see what Medicare Advantage plans have to offer; learn about plans that have a zero premium and include RX coverage too, then this is your time to do research. If you do end up wanting to enroll in a Medicare Advantage with Prescription drug plan, you don’t need to worry about health conditions because enrollment is not subject to underwriting and guaranteed issue (unless you have end stage renal disease).

For those of you already on a Medicare Advantage plan, you need to be aware of a few important things. Keep an eye out for your, “Annual Notice of Change” otherwise known as “ANOC”. This will come from your current insurance carrier late September and it will show line by line any benefits from 2015 in comparison to 2016 that are changing.

The other really important information reported in your Annual Notice of Change is any drug plan changes. Sometimes carriers drop certain drugs from their formulary and if that drug is one you take, you need to know about that!! If this happens to you, it makes sense to shop for a new plan. Another change that happens with RX coverage is changes in drug tiers. Most Rx plans have tier 1 and tier 2 that are generic drug tiers, tier 1 is less expensive than 2. Sometimes the news is good in your ANOC and your tier 2 drugs are now tier 1. If the change is in reverse, your tier 1 drugs are now tier 2 and if you take a lot of generic medication, those small increases can add up. More financially substantial are the name brand tiers, generally tier 3, 4 and 5 (usually getting more expensive the higher the tier number). If your tier 3 drug becomes a tier 4 drug, this is a change could cost you double digits.

Bottom line: READ YOUR ANNUAL NOTICE OF CHANGE. If you don’t like how the changes in your plan affect you, then please contact me to schedule a personalized, no fee consultation in my office or at your home. I’m already booking appointments starting October 1st.

I continue to see a growing number of clients meeting with me that have no idea how to start the process of Medicare, or what the pitfalls or benefits are while they’re still working, but are age 65 or older. Common Q & A’s are:


If I’m 65 when I retire can I enroll in my retiree benefits or COBRA first and then go on to Medicare later?

No! These benefits don’t count. You need to sign up for Medicare at age 65 in both of these situations.

If I have insurance from an employer (mine or my spouse) can I delay enrolling in Medicare at age 65?

Yes! But only is the employer has 20 or more employees. Once your employer insurance ends you have 8 months to enroll in Medicare without late enrollment penalties. I would suggest you compare the options open to you in Orange County’s Medicare market for deciding to stay on group insurance. Many times group benefits are more expensive and not as good as what’s available to you as a Medicare beneficiary.

I have small group insurance, how does that work with Medicare?

The best option is to enroll in Medicare at age 65. Then, compare the Medicare options available to you in Orange County to round out your coverage vs. staying on your employer’s plan as the secondary insurance. Most times you’ll find your options are less expensive and richer in benefits that what you small group health plan offers.

I didn’t realize I had a deadline to sign up from Medicare at age 65 and I missed my enrollment window, now what?

Sorry, but you have to wait until the general enrollment period which runs January 1st to March 31st every year. Go to your local social security office to sign up during that timeframe. Unfortunately your coverage won’t start until July 1st and you’ll have late enrollment penalties for you Part B portion of Medicare and your RX coverage(Part D) (some exceptions for the RX late enrollment penalty exist)

If I have employer insurance should I enroll in Medicare at age 65?

I would say that it’s a waste of your money to do so if your employer plan is 20 or more workers. Reason being is that the employer plan in this situation is automatically your primary plan. Medicare Part B comes with a price-tag ($104.90 for the standard premium, it can be higher). So if your employer plan is decent, you would be paying for something that would never be utilized in most cases.

Are you one of the thousands of people in Orange County that bought an insurance plan from Assurant Health?

They were a great option for those not utilizing Covered California and wanting a broad network. Notices were sent out in June that Assurant will be leaving the Health Insurance Marketplace in 2016 due to losses of 40-50 million in the first quarter of 2015. So that leaves many not knowing where to turn to make sure they obtain new coverage that allows them keep their existing doctors and hospitals, as well as having their medications in formulary and a comparable plan. This is what I specialize in and I’m here to help. Open enrollment is Nov. 1-Jan. 31st this year. December 15th is the cut-off for January 1st coverage.

Here are a few things to keep in mind:

  1. 1. Don’t be concerned about pre-existing conditions, the Affordable Care Act does not allow underwriting, the insurance companies must accept you “warts and all”.
  2. Doctors will be doing some changes this Fall. If you want to keep your current doctors and favorite hospital make sure the updated provider networks are vetted this Fall.
  3. Open enrollment is the time to change plans if the plan that you had in 2015 doesn’t meet your needs for 2016. Once 1/31/2016 is behind us, you will be locked into your plan for the year.

In September the new plans, prices and players will be announced and the doctor’s networks will be in place.  I will be scheduling appointments either in person or by phone for those that contact me to determine what company it is best to place you with and we’ll revisit your plan selection at that time.

I’m predicting a busy September calendar, so contact me soon to schedule your appointment.

If you don’t have health insurance in 2016, you’ll pay the higher of these two amounts: 2.5% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.)

The maximum penalty is the national average premium for a Bronze plan. Or, you’ll pay $695 per person ($347.50 per child under 18). The maximum penalty per family using this method is $2,085. Bottom line is it’s a lot of money and your risking even greater financial loss, and possibly ruin by going uninsured. I know it can seem daunting, but for someone into their third year handling Covered California it’s really not. That’s why getting FREE help from me makes so much more sense than just putting your head in the sand and hoping it goes away, because it’s looking like the current process is here to stay.

Generally someone only applies for insurance through Covered California if their income is close to the guidelines below. You have to estimate your income for the upcoming year, so if you aren’t sure what it will be exactly, applying through Covered California will ensure that you DO get the Federal subsidy money that you deserve at tax filing time if you estimated making more money than you actually did.

If your income is under $47K as an individual, $63K as a married couple or $97K as a family of four (for example, not limited to) you have options with Covered California. You have until 1/31/16 to enroll in a plan for 2016 to avoid the penalty for 2016. If your income is higher, then we apply directly to the insurance plans for coverage. For coverage to start January 1st you need to apply by 12/15/15. If you’d like assistance understanding your choices, call to schedule a phone consultation with me, once again, my services are free.