Health Insurance Matters: Reader’s Help Needed

Reader’s Help Needed

There is an overwhelming need in our community for health insurance for people who typically are too poor to purchase this newspaper each week. The doctor’s offices and Social Services are sending them over once identified, but it is a real pity that these people in need are not getting the optimum care. Many are of the belief that Medi-Cal is their only option. Not true.

Many of the Medicare Advantage HMO plans provide more benefits and choice, often reducing their prescription costs to $0 and providing free transportation to and from the doctor’s office.

There is even a plan that provides money for non-prescription over the counter (OTC) medications and medical supplies. How about being able to go to Walmart and buy the OTC items?

Many people think that the only time to change plans is during the Annual Enrollment Period, (October 15 to December 7.) While this period is available to all people with Medicare Advantage HMO or Prescription Drug Plans (PDP), there are other election periods provided in the law.

Medicare rules provide a new enrollment period effective from January 1 to March 31 called the “Open Enrollment Period.” This time frame allows for one change from an existing Medicare Advantage plan (HMO or PPO) to another plan or back to original Medicare.

“Special Enrollment Periods” are available year-round for other Medicare Advantage people. Persons with certain medical problems, such as diabetics, pre-diabetics and certain cardiac conditions can join or change plans year-round. As I mentioned earlier, people who qualify for Medi-Cal [by being eligible and on a “low income subsidy” from Social Security (LIS)] can enroll between January and September and even switch plans once a quarter during this time frame.

During this recent holiday season, we provided toys for the disadvantaged. We gave food to the homeless and needy. I would love to open my practice to help those less fortunate and provide no cost health plans where it is appropriate.

As a well-informed reader, if you can identify these people to me, they will appreciate it. I hope to announce in the first quarter of this year a new program for the Kern River Valley that will provide specialized help for people with dementia and chronic severe mental problems.

I would like to offer all my readers and clients a very happy and healthy New Year.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 27 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 or visit him on the web at