Health Insurance Matters: Been Too Busy to Write

By Harry Thal
Special to the Sun


A colleague asked me how I could come up with something fresh for my column each week. For about 18 years I have been writing for local papers. Truth be told, it hasn’t been easy, and “every” week became inaccurate. I often have nothing to say, and other weeks, too much. These past few weeks I have been gone from the page, with only my front page banner ad on the bottom of page 1. I have been too busy to write!

Blue Shield put an offer to the Medicare public that can’t be ignored. It is unprecedented and has created so much work, that I am once again going 7 days a week, often 12-14 hours a day.

The offer is very simple. If you are on Medicare and have any Medicare Supplement or Medicare Advantage HMO or PPO, they want your business. Their prices are even often lower than what they have been charging existing clients.

Rarely can a person enroll and get full coverage without having to answer medical questions. The Blue Shield “Underwriting Holiday” for the month of January is allowing your current coverage to act like a “get out of jail free card.” No medical questions!

George was in great health when he turned 65. He chose to join a Medicare Advantage HMO plan, as there was no monthly premium, his doctor was on the plan, it covered his maintenance prescription and the costs were nominal when he needed to use the plan. How was he to know that the top specialists in the area are not “participating physicians” and his doctor needed to seek permission before a referral for something as simple as a CT Scan. When George looked into changing to a plan with better choice and fewer hassles, he learned that his current health history allowed every insurance company to reject his application. I helped George and many others get a plan due to the Underwriting Holiday.

Sally’s husband, may he rest in peace, set her up with great insurance. The Plan F policy pays for everything she needs. She can go to a specialist in Santa Barbara for her eyes and a surgeon in Los Angeles. There is almost no limitation to her access for care anywhere in the United States. Her husband did well. But, he didn’t foresee that the cost of the policy kept going up, and Sally’s fixed income was straining to make the monthly premiums. The Blue Shield plan “Extra” provided Sally with an “out” while maintaining the identical benefits he had set her up with. The new plan, lowered her monthly cost and also provided “Extra” benefits like a Hearing, Vision, and Silver Sneakers Gym membership.

Lastly, there are several people in the Kern Valley, and many in the Ridgecrest area who have purchased a Medicare Advantage PPO plan. The promise was that they could see more doctors than the Medicare Advantage HMO. The rub is, that there are copays whenever you go to use the policy, and some doctors don’t accept it. They feel trapped, as now they no longer can qualify for a Medicare Supplement.

Now through the end of January, there is that once in a lifetime opportunity to get the coverage they should have gotten in the first place. A comprehensive affordable supplement with virtually no co-pays or deductibles. And choice. If the doctor accepts Medicare, you are covered. Plain and simple.

The January 31 deadline is fast approaching. Now back to processing the stacks of applications so more people can lower their current Medicare Supplement costs while increasing their access to benefits.

I wonder if Valley Fitness in Lake Isabella will need to get a bigger facility to accommodate all the Silver Sneakers members this plan provides.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 24 other states. His offices are in Kernville. He is a member of the Society of Certified Senior Advisors and Past-President of the Kern Association of Health Underwriters. He may be reached at 760-376-2100, e-mail harrythal@aol.com or visit him on the web at www.harrythal.com.