CMS Proposes Pay Raise for Medicare Advantage Plans

medicare advantagePrivate insurers that offer Medicare Advantage plans will receive a nearly 1 percent raise from the federal government next year, the Obama administration announced Monday.

The Centers for Medicare and Medicaid Services said participating plans will receive a 0.85 percent hike in reimbursements in 2017, down from the 1.35 percent increase it proposed in February, based on revised estimates of how much medical services will cost.

The announcement caps an intense lobbying campaign by insurers and some in Congress, who urged the administration not to shortchange the popular alternative to the government health care program for seniors.

Medicare Advantage plans received a 1.25 percent raise for 2016 after the administration reconsidered a proposed cut.

Nearly 17 million people, nearly a third of all Medicare recipients, are enrolled in the plans run by insurance behemoths like Humana, Aetna and UnitedHealth Group, while the rest rely on the government’s fee-for-service model to reimburse doctors.

The Centers for Medicare and Medicaid Services noted that individual plans may receive even higher reimbursements through bonus payouts for improving the quality of care they provide to beneficiaries.

“With these policies, we will continue to see improvements in growth, affordability, benefits and quality for millions of seniors and people living with disabilities,” acting CMS Administrator Andy Slavitt said.

The administration said it will phase in a contentious change to how it reimburses certain employer-linked plans for retirees over the next two years.

America’s Health Insurance Plans, the industry’s main lobby, said its efforts and outreach by members of Congress forced the Centers for Medicare and Medicaid Services to “mitigate the negative impact” of some of its proposed changes to the program.

“Yet, more can be done to ensure stability for more than 3 million seniors who depend on Medicare employer retiree plans,” said Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. “We urge policymakers to focus on policies that will strengthen the Medicare Advantage program moving forward and ensure high-quality, affordable coverage for seniors and vulnerable beneficiaries.”

For years, America’s Health Insurance Plans has contended that any cuts to payments would cause a trickle-down effect that increases premium costs and reduces provider options for seniors, a particularly sensitive issue in a pivotal election year.

The group pointed to the rising number of congressional lawmakers who called on the administration to resist cuts — 287 House and Senate members in 2014 compared with 404 in 2016, a 41 percent increase.

Calls to protect Medicare Advantage grew stronger after the passage of the Affordable Care Act, with Republicans saying President Obama “robbed” hundreds of billions of dollars from the program to pay for the rest of his signature health care law.

Congressional Democrats said the administration merely scaled back payments to private insurers that administer the plans so they were in line with what traditional Medicare pays.

Sean Cavanaugh, a deputy CMS administrator, said Monday that Medicare Advantage has grown “stronger and more popular” every year since enactment of the Affordable Care Act in 2010. Enrollment has grown by 50 percent since the law was enacted, and premiums have dropped by 10 percent from 2010 to 2016.

If you have questions regarding your Medicare Advantage Plan please call our office anytime at (909) 792-3300


Article By Tom Howell Jr. – The Washington Times
Monday, April 4, 2016


To receive more information on your Medicare options visit


terridogsHi everyone, I have a couple of milestones I’d like to share with you. First, Terri and I are the proud owners of two 5 month old German/German Shepherd puppies named King and Cali (although, they think they own us!). We have them on a property in Cherry Valley we call Litchfield Hills.

Secondly, to better serve my clients and friends, I recently earned a new Designation/Certification called NSSA (National Social Security Advisor). It is a great joy of mine to assist you from year to year with your Medicare Plan choices. I can now help you with your Social Security questions ( such as, When would be the best time to take your benefits?), as well as Strategies to implement in Retirement such as Protection with Moderate Gains for your hard earned dollars as well as Income for Life.

Good News! Medicare Advantage is getting a Raise! Although small, it beats the cuts that have been occurring in recent years. This means your Plan should remain strong for 2017.

My two new pups are proving that you really can “teach an old dog (me) new tricks!”….Until next time, have a Wonderful Spring,



To receive more information about your Medicare options visit

10,000 People Are Now Enrolling In Medicare – Every Day

President Obama wants you to know: He loves America’s seniors. (And is even intimidated by a few of them.)

“The toughest justice on the Supreme Court is also the oldest … the notorious RGB,” Obama joked at Monday’s White House Conference on Aging, name-checking 82-year-old Ruth Bader Ginsburg. The president also warned attendees not to race Diana Nyad, unless they wanted to get dusted by the 65-year-old swimmer.

And thanks to advances in health care and our nation’s safety net, all of America’s seniors are “living longer. They’re living healthier,” Obama added, in a more serious vein.

But here’s a sobering statistic that President Obama glossed over: About 10,000 people are now enrolling in Medicare every day.

That’s a record surge in Medicare enrollment, and it’s expected to continue for the next 15 years, as the Baby Boomers age into their golden years. It also means that the total number of Medicare beneficiaries is expected to double within the next twenty years.

The CBO projects that 80 million Americans will be Medicare-eligible by 2035, if current trends hold.

Medicare65 graph

Some analysts have a name for the wave of change that’s coming — they call it the “silver tsunami.”

And it has huge ramifications for the rest of our economy, and especially for the health care industry.

Older Americans, for instance, generally need more ongoing and expensive care. The government currently spends more than $10,000 per Medicare beneficiary every year, with costs spiking in an enrollee’s last years of life.

“From the government’s perspective, they will spend, on average, nearly $450,000 for the new age 65 Medicare beneficiary during their expected lifetime,” actuaries at the Health Care Cost Institute reported in 2013.

It’s another reason why White House leaders are so insistent on changing how Medicare pays for patient care, in hopes of reining in federal spending. (And there are signs for optimism here; as Margot Sanger-Katz wrote at the New York Times last year, Medicare spending per capita is actually falling.)

America’s changing demographics already are having a noticeable effect.

In the past decade, the number of all U.S. jobs has grown by 6% — but the number of home health jobs has grown by 60%, as more aging Americans with chronic illness need support and care. Meanwhile, more doctors are hanging up their stethoscopes, as anunprecedented number of physicians hit retirement age.

And one driver for Aetna’s $37 billion acquisition of Humana is that Humana is a major player in the Medicare Advantage sector — a rapidly growing insurance market.

There’s another demographic change worth noting: America’s fertility rate has reached a record low.

While total births have been relatively constant — there are nearly 4 million children born in the United States every year — the number of children born per person has fallen dramatically, the CDC reports.

(For contrast, there were nearly 4.3 million births in 1960, when the U.S. population was 180 million, versus 3.9 million births in 2013, when the U.S. population was 317 million.)

That won’t mean much in the short-term. But as the number of elderly Americans steadily climbs as a percentage of the population — about 20% of all Americans will be Medicare-eligible by 2030, up from 13% today — it will put increasing pressure on working-age Americans to support them.

And we’re going to have to grapple with hard questions. How will we pay for a much-bigger Medicare program? And who will care for our seniors?

But some are seeing the humor in the changing face (and needs) of America, too. “Invest in Depends, not Pampers,” the Tenneesse Globe quipped on Sunday.

This article was provided by

What seniors have to say about protecting Medicare Advantage

medicareMedicare Advantage provides high-quality, affordable, coordinated care to nearly 16 million seniors and individuals with disabilities. Additional proposed cuts to the program would result in these beneficiaries facing higher costs, reduced benefits, and fewer coverage options.

Recently proposed cuts to Medicare Advantage would increase costs and reduce benefits for California seniors and individuals with disabilities who rely on the critical program. New data from Oliver Wyman shows Medicare Advantage cuts would cost California beneficiaries $100-$120 per month. Last month, seniors shared their Medicare Advantage stories with California Reps. Mimi Walters and Norma Torres, who were among 40 California lawmakers who recently sent letters to CMS to protect seniors’ MA benefits.

Below are some Coalition members in California who would experience negative effects from additional cuts. Here’s why it’s important to protect their Medicare Advantage benefits:

– Stephen Henderson of Palm Springs, CA:
“Without my Medicare Advantage program my prescriptions would be too expensive. I wouldn’t be able to afford them. I am very happy with my doctors and my program benefits. Why would Congress want to take money from a program that works?”

– Carolyn Hunley of Palm Springs, CA:
“Being able to go to the gym and participate in classes that are designed for seniors is just one of the things I like about my Medicare Advantage program.”

The Five-Star Rating System and Medicare Plan Enrollment

Part D drug plans and Medicare Advantage plans vary greatly in terms of costs and coverage.  Each January, plans change their coverage and costs for the new calendar year.  Every fall, you should go over your plan’s coverage and compare it with other plans in your area to make sure you have the coverage that is best for you. Examine a plan’s coverage, costs, drug coverage and the pharmacies in its network to see if it best meets your needs.  After considering those factors, you can use the plan’s star rating from Medicare to help you select a plan that’s right for you.

What are the Medicare Star Ratings?
Medicare uses a Star Rating System to measure how well Medicare Advantage and prescription drug (Part D) plans perform. Medicare scores how well plans did in several categories, including quality of care and customer service. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. Medicare assigns plans one overall star rating to summarize the plan’s performance as a whole. Plans also get separate star ratings in each individual category reviewed. The overall star rating score provides a way to compare performance among several plans. To learn more about differences among plans, look at plans’ ratings in each category.

Medicare reviews plan performances each year and releases new star ratings each fall. This means plan ratings change from one year to the next. Medicare sets the categories and reviews each plan the same way. You should look at coverage and plan costs, such as if the Part D plan covers all the drugs you take and has a premium you can afford before you consider the star rating.

Medicare health plans are rated on how well they perform in five different categories: Staying Healthy: Screenings, Tests, and Vaccines, Managing Chronic (Long-Term) Conditions, Plan Responsiveness and Care, Member Complaints, Problems Getting Services, and Choosing to Leave the Plan, Health Plan Customer Service

Medicare drug plans are rated on how well they perform in four different categories:
Drug Plan Customer Service, Member Complaints, Problems Getting Services, and Choosing to Leave the Plan, Member Experience with Drug Plan, Drug Pricing and Patient Safety


Medicare Open Enrollment Oct. 15th to Dec. 7th

Citibank conf. room

Which Plan is Right for Me?

“If you’re happy with your Plan, you can keep your Plan”. Where have we heard that before? Regarding Medicare Advantage plans, in many cases that is true, however this year in particular in the Inland Empire a popular Chronic Illness diabetic plan called SCAN Balance is being discontinued. I have already met with many of you on this plan, dialed in your medications and helped you select a new plan that best meets your needs. If you’re on this plan and have not chosen a new one for 2015 please call my office and schedule an appointment as soon as possible.

It is less than half way through Open Enrollment and I can tell you where most of my clients have been gravitating to: SCAN Classic plan; AARP Medicare Complete Plan 2 by United Health Care; Humana Gold Plus; Blue Shield 65 Plus and Health Net’s Healthy Heart and Gold Select plans.

We have other plans too. Everyone’s situation is unique, and requires balancing your medications, benefit requirements and medical groups.

NEWS FLASH…Loma Linda Medical Groups and Hospital are now available as a Primary for the AARP Medicare Complete plans.

I really do enjoy the challenge year to year assisting you in this ever changing health care landscape. Sometimes it just takes a phone call; other times a face to face meeting.

So, if you are happy and your benefits haven’t changed much, you can keep your plan and you need do nothing. If you’re not sure PLEASE call and let’s schedule a review.

As we all enter this holiday season, Terri and I are so thankful for you and wish you and yours a
Wonderful Thanksgiving and Blessed Christmas and New Years.

All the best,


CA Lic #0B56846



Medicare Advantage defies expectations by growing

medicare advantageIf we used tennis scoring to track the progress of healthcare reform, this would be the moment to declare: advantage Advantage.

Obamacare opponents have been warning for several years now that Medicare Advantage, the private plan option that seniors can pick instead of traditional fee-for-service Medicare, would fail because of the healthcare law’s impact on the program. The prediction was that the gradual elimination of extra federal reimbursements to Medicare Advantage would kill it. But the opposite is happening.

Advantage plans, which combine Part A (hospitalization) Part B (outpatient services) and usually Part D (prescription drugs), are on a big-time roll. Enrollment has jumped an impressive 10 percent in each of the past three years, according to data compiled by the Kaiser Family Foundation (KFF), a non-profit healthcare research and policy organization. About 28 percent of all Medicare enrollees this year are in an Advantage plan

The growth of Advantage likely will shift into an even higher gear during the next few years following the launch of the state public insurance exchanges under the Affordable Care Act (ACA). Most are managed care plans – 65 percent are health maintenance organizations (HMOs) and 22 percent are preferred provider organizations (PPOs), according to KFF.

Savings on premium costs are a big driver of Advantage plan growth. Enrollees pay their regular Part B premium, which is$104.90 this year. The Advantage plans also can charge a supplemental premium, but many don’t. This year, 55 percent of enrollees are in plans with no extra premium, and two-thirds of HMO Advantage plan members pay nothing extra, KFF says.

That means Advantage participants do not pay standalone premiums for prescription drug coverage, averaging $30 per month this year. They also are not paying for Medigap supplemental plans, which are popular in traditional Medicare and cover deductibles and coinsurance for long hospital stays and outpatient services, and help lower out-of-pocket costs.

Advantage plans also are gaining because the baby boomers coming into the Medicare system are accustomed to managed care.

The savings on premiums are an important plus for healthy seniors, since their overall usage of care will be low and out-of-pocket costs will be minimal. Baker urges less-healthy seniors to proceed with caution.

If you’re a relatively healthy 65-year-old who goes to the doctor once a year, you will save some money on premiums,but costs can escalate if you get sick.

If you are inclined to take traditional Medicare, there is an advantage to picking it when you first enroll because the Medigap policy won’t be able to exclude you for any pre-existing condition or charge a higher premium due to any past health problems. Depending on your state, you might have trouble getting a Medigap policy, or have to pay more, if you try to get a policy past that point.

Sincerely,  George
California License #0B56846
(909) 792-3300

When to Enroll in Medicare Advantage or Prescription Drug Plans

perscription drug plansAfter you’ve completed your initial enrollment in Medicare Parts A and B, there are some key dates to keep in mind. Review these dates and explanations to get a clear picture of when to take action.

Initial Enrollment Period (IEP)
For most, your IEP begins three months before the month you turn 65, runs through your birth month and ends three months after your birth month.

If you wait to enroll in a plan, there’s a chance you will have fewer plan choices and you may have to pay more.

Annual Enrollment Period (AEP) – Oct15 – Dec 7
During this time, you may enroll in a Medicare Advantage plan for the first time OR you can change prescription drug plans, Medicare Advantage plans, or return to Original Medicare. Coverage for enrollment changes takes effect on January 1.

Medicare Advantage Dis-enrollment Period Jan1 – Feb 14
If you’re in a Medicare Advantage Plan, you can elect to return to your Original Medicare benefits from the federal government. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.

Feb 15 – Oct 14
During this time you will not be able to switch coverage unless you qualify under certain circumstances for a Special Enrollment Period.

Generally, you must stay with your current coverage until January 1, when any new coverage you chose during the Annual Enrollment Period begins. – If you or someone in your family is 65 or older and is in need of a Medicare Supplemental Plan or already has a plan, but wants to make sure that it is the right plan please give us a call (909)792-3300 or (888)891-5557 or go to our website  and we will give you a quote and help you keep money in your pocket

How to Get Dental Coverage with Medicare


What does Medicare cover when it comes to you and your teeth? Not sure?  This article will give you the answers to your questions and if you would like more information you can always call me anytime.

Have a great day!

George Litchfield
Medicare Plan Specialist

Call me today at 888-891-5557


Medicare does not cover routine dental care. It doesn’t cover cleanings, fillings, or any of the usual dental procedures. It doesn’t pay for extractions or dentures. In general, you are responsible for the cost of all your regular dental care.

Medicare will pay for certain dental procedures related to a covered medical condition. For example, it will cover jaw reconstruction after an injury or extractions before cancer radiation therapy. These select covered dental procedures must be necessary to treat a non-dental condition. They must be performed at the same time as treatment for the covered condition and by the same doctor or dentist.

Medicare Advantage with Dental

Many Medicare Advantage plans offer dental coverage, as well as vision, hearing and prescription drug coverage—all in one plan.

Medicare Advantage plans are private plans offered by Medicare-approved insurance companies. The plans combine all the coverage of Medicare Parts A and B and may have additional benefits, such as dental. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. Medicare Advantage is also called Medicare Part C.

Coverage and costs with Medicare Advantage vary from plan to plan. With some plans, you pay no additional premium. (You must continue to pay the Part B premium to Medicare.) Other plans may charge a premium, and some charge extra for dental or other additional benefits. In addition, every Medicare Advantage plan has a service area—a geographic area in which it operates. You must live in the service area in order to join a plan.

You can research Medicare Advantage plans in your area using the Plan Finder at You may also want to ask your dentist what plans he or she participates in. Some Medicare Advantage plans require you to use a provider that’s part of their contracted network.

Other Dental Options

If you want to stay with Original Medicare and receive your benefits directly through the federal government, then your dental options are limited. You can:

  • Pay out-of-pocket for all your regular dental care needs
  • Buy a private dental insurance plan
  • Look for low-cost or discounted dental services

Some dental and dental hygiene schools have clinics that allow students to gain experience while providing quality care at a reduced cost. Experienced, licensed professionals supervise the students. You can check with the American Dental Association and the American Dental Hygienists Association to see if there is a school near you.

Your state or local health department or United Way chapter may be of help in locating low-cost dental care in your area. In addition, the Bureau of Primary Health Care, a service of the Health Resources and Services Administration  (1-888-Ask-HRSA), supports federally-funded community health centers across the country that provide free or reduced-cost health services, including dental care.

–This information is provided by Medicare Made Clear – If you or someone in your family is 65 or older and is in need of a Medicare Supplemental Plan or already has a plan, but wants to make sure that it is the right plan please give us a call (888)891-5557 or go to our website  and we will give you a quote and help you keep money in your pocket.

How to Appeal a Medicare Decision – Redlands CA, Yucaipa CA


I hope all is well with you. Below in the article is some useful information for you or someone you know that is on Medicare.

Have you ever had these questions come up?

How do I Appeal a Medicare Decision?

When can I appeal a payment or coverage decision?

What happens if I decide to file an appeal?

What’s the first step of filing an appeal?

If so this article has the answers for you.  And if you haven’t this could be valuable information for the future.

Have a wonderful day!

George Litchfield
Medicare Plan Specialist

Call me today at 888-891-5557



Medicare - Redlands CA - George LitchfieldAn appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. That decision can be made by Medicare or by the private Medicare-approved health plan that administers your Medicare Advantage (MA/MAPD) plan, prescription drug plan (PDP) or special needs plan (SNP).

When can I appeal a payment or coverage decision?

You can file an appeal if Medicare or your plan denies one of the following:

  • Your request for a health care service, supply, item or prescription that you think you should be able to get.
  • Your request for payment for health care service, supply, item or a prescription drug you already got.
  • Your request to change the amount you must pay for a health care service, supply, item, or prescription drug.

You can also appeal if Medicare or your plan stops providing or paying for all or part of an item or service you think you still need.

What happens if I decide to file an appeal?

If you decide to appeal, first ask your doctor, health care provider or supplier for any information that may help your case. See your plan materials, or contact your plan for details about your appeal rights. Medicare and all companies that provide Medicare plans are required to help you file an appeal.

The appeals process for all types of Medicare plans has five levels. At each level, a decision about your appeal is made and communicated to you in a letter. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you’ll be given instructions in the decision letter on how to move to the next level of appeal.

What’s the first step of filing an appeal?

Although we won’t go through all five steps of an appeal process, we can describe the first step. How you file an appeal depends on the type of Medicare coverage you have. But no matter what type of Medicare plan you have, at any step of the appeals process, you can—and may want to—ask your doctor, health care provider or supplier for any information that may help your case, or other help.

Original Medicare

If you’re on Original Medicare, then every three months you’re mailed a Medicare Summary Notice, or “MSN.” An MSN shows all services or supplies that health care providers and suppliers billed to Medicare for your care during the three-month period. It shows what Medicare paid, and what you may owe the provider. You can also view your MSNs electronically on

Your first step is to find the MSN that shows the service or supply you’re appealing. You then have two options to file the appeal:

1. Fill out a Redetermination Request Form (PDF). Send it to the Medicare contractor at the address listed in the “Appeals Information” section of your MSN. Or, you can…

2. Follow the instructions on the back of your MSN, and send the request for an appeal without the Redetermination Request Form. You provide the same types of information as what’s asked for on the form, and send it to the Medicare contractor listed.

Generally, you get a decision from your Medicare contractor within 60 days after they get your request. The decision is called a “Medicare Redetermination Notice,” and it can come as a separate notice or as part of your MSN.

Medicare Advantage Plan (Part C)

You have the right to ask the company that administers your Medicare Advantage plan to pay for, or cover, health care services or items you believe should be covered. This request for services or supplies is called an “organization determination.” You can either ask for a determination yourself, or have your doctor or someone representing you ask for one.

Organization determinations typically take 14 days. If you or your doctor thinks your health could be harmed by waiting that long, you can ask for an “expedited” or fast determination. Then your health plan has 72 hours to give you a decision.

Your plan can approve your request, or partially or fully deny it. Your plan will send you a written notice explaining why, and give you information on how to file an appeal. This process may vary depending on your plan, so follow the instructions provided. However, regardless of your plan, you are allowed to ask for a copy of your file containing medical and other case information.

Medicare Prescription Drug Plan (Part D)

Appealing a decision for a Part D plan typically means working with your plan to get coverage for a prescription drug that you feel you need. As with a Medicare Advantage plan, this usually involves either you or your doctor (or representative) working directly with the company that administers your Part D plan.

Prescription drug coverage relates primarily to your plan’s formulary, or drug list. For more information, see the previous Medicare Made Clear blog post Medicare won’t cover a prescription I need—what now?.

Medicare Special Needs Plan (SNP)

Your Medicare SNP needs to tell you in writing how to file an appeal. After you file an appeal, the plan reviews its original decision. If your plan doesn’t decide in your favor, the appeal is reviewed by an independent organization that works for Medicare, not for the plan.

–This information was provided by Medicare Made Clear

Georgelitchfield – If you or someone in your family is 65 or older and is in need of a Medicare Supplemental Plan or already has a plan, but wants to make sure that it is the right plan please give us a call (888)891-5557 or go to our website  and we will give you a quote and help you keep money in your pocket.