Annual Enrollment Period (AEP) – It’s just around the corner

Today all the Medicare Advantage and Prescription companies have released their 2020 plan benefits. For most the easiest way to review the changes to their current plan will be via their Annual Notice of Change (ANOC) letter. This letter was mailed out to all current members and should have arrived by 9/30/19. If you don’t have this letter or have misplaced it, you may contact your carrier to resend it or for many you will be able to access it electronically as many Insurers make them available in their websites.

The ANOC letter contains the plan benefit details for the following year. It’s an easy way of comparing your current plan with the changes coming up for 2020. Consult your agent to make sure that you understand the changes.

It’s important to do a medication cost comparison as the ANOC letters don’t give you a year by year comparison on what you can expect to pay. But it’s possible to compare your medication costs. Contact your agent to help you. There are drug price comparison tools on most Insurer websites, in addition has their own. Note that it’s important that you provide the correct medication name (brand vs generic), how many you take a day, how often they are refilled (e.g., 30, 60, 90 a month, or every 3 months) and what pharmacy you go to refill them. All these details can change the cost projections significantly. 

For some Medicare beneficiaries their Insurer letters will notify them that their current plan will no longer be available for the following year. This is no cause for alarm, as there is plenty of time to review the options available. Some carriers will offer an alternative plan if they remove your plan from the market, the alternative option may come in a separate letter. But no matter what plan is selected, switching will require action on the part of the beneficiary. Talk to your agent to make sure that you select the plan that meets your needs.

Starting October 15th plan changes for AEP could be submitted to the Insurers, those changes will be effective January 1st 2020. For most the last day to submit applications for plan changes is December 7th.

Depending on your current needs other benefits may be more important. Think about what you may need for the following year. Perhaps you have a treatment or procedure coming up and you want to know what out of pocket costs you can expect.

Things you should compare:
  1. Premium
  2. Maximum out of Pocket
  3. Co-Pays
  4. Co-Insurance
  5. Network – HMO vs PPO
  6. Referrals for HMO’s – do I need a referral to see a specialist?
  7. Dental, Vision, Fitness, Hearing
  8. Over the Counter (OTC)
  9. Prescriptions – Are my medications still covered and what are the estimated cost projections?
  10. Star Ratings

If you like your current plan and you want to renew it with the changes you don’t have to take any action, the plan renews automatically.

Making a plan selection is very important and personal so let’s take our time to review the options, let’s ask questions and find the plan the fits your needs.

Medicare Advantage and PDP – Annual Enrollment Period – Coming Soon!

Medicare n You

That’s right! Another Annual Enrollment Period (AEP) is right around the corner. On October 1st all Medicare Advantage and Prescription Drug Plan companies will release their 2019 plan benefits. If you already have one of these plans you’ll soon get the Annual Notice of Change where the insurers will highlight the changes to your plan for 2019.

The AEP begins on 10/15 and will end on 12/07. The last enrollment you submit during this time frame is the plan that you will be enrolled in during 2019.

Once it’s AEP – “What should I do?”

It’s that time where you’ll want to do the following:

  1. Review the changes to your current Medicare Advantage or Prescription Drug plan.
    1. Has the Premium Changed?
    2. How have the following benefits changed:
      1. Co-pays, Maximum Out of Pocket, Dental, Vision, Hearing, Deductibles, Transportation, Over the Counter, Drug Costs & Formulary
    3. Is my plan still being offered for 2019 or will I need to change to another one?
    4. Will my Doctors still be in-network?
    5. Will my medications still be covered?
  2. If you have a Supplement evaluate your monthly premium costs and ask yourself if it’s time to make a change. Will a Medicare Advantage lower my out of pocket costs?
  3. Compare new plan options in the market.
    1. Is there a plan that offers you more of the benefits that you need?
      1. Dental
      2. Vision
      3. Lower Co-pays
      4. Transportation
      5. Hearing Aids
      6. Lower monthly Premium
      7. Part B premium Pay Back/Refund
  4. Evaluate whether you can benefit from assistance of a Health Insurance Agent. They can help you evaluate the options for 2019, make your research a lot easier.

Here at Ask Gabe, Inc. we are already hard at work at evaluating ALL the plans for 2019. We will be happy to help you identify the plan the can best fits your needs. Call or Email and we can discuss how we can help you during the Annual Enrollment Period and beyond.

We work hard to help our clients every year in choosing the plan that minimizes their healthcare expenses all the while getting the most value. We are also available to help them throughout the year with any issues or concerns. So if you want an agent that cares about your needs and is available to help you when you need it, give us a call.

Medicare Educational Meetings – A must see!

Since I started helping seniors with health insurance, I knew there was a need for educational seminars in my community. I’ve been working hard to contribute by scheduling educational meetings in Cobb, Douglas and Fulton county centers. The attendance at each of the events has been excellent. Two weeks ago we had 25 attend with just a couple of days notice!

The point of a Medicare educational event is to understand the different parts of Medicare, see when you are eligible and acquire general information about the Medicare products available. I also like to share information about the State programs that help lower income seniors save money on medications, part B premium and healthcare costs. There are two great programs available, one is the Medicare Savings Program and the other is called Extra Help.

If you are interested in having a Medicare Educational meeting at your center or place of employment please let us know and we’ll add it to the calendar.

There are no fee nor are products promoted at educational events.


Should I enroll into Medicare A & B if I continue to work?

Working Past 65This is a very common question and the answer will depend on several factors. While the topic can be overwhelming there is no need to over stress.

Factors that can affect the answer include:


  • Employer Size
  • Disability
  • Cobra
  • Veteran Benefits
  • End Stage Renal Disease (ESRD)

First you’ll want to understand how your employer group coverage will be affected once you are eligible for Medicare. Your group coverage through your employer could be affected even if you don’t sign up for Medicare when you turn 65, so pay close attention.

Coordination of Benefits

The first big thing about Medicare we need to cover, in relation to our topic, is coordination of benefits. According to coordination of benefits ‘is a way to figure out who pays first when two or more health insurance plans are responsible for paying the same medical bill’. While it’s logical to think that this only applies when you have two insurances, the truth is that its not. Some group insurances could deny paying a bill just because they know you are eligible for Medicare.

The reason for this is because Medicare has set rules on who pays a bill first. An ample list of scenarios can be found on a document called “Who pays First” created by the Center for Medicare and Medicaid Services (CMS). It’s available on

Employer Group Size

What you need to know is if your employer insurance plan is suppose to pay first or not. For most is as easy as knowing if your employer group has less than 20 employees or not.  If your employer has less than 20 employees then Medicare becomes the “primary payor”, which basically means that they are suppose to pay the bill first. Now here is the tricky part, this applies even if you haven’t signed up for Medicare yet. Wait, what?

Yes, if you are 65 and are eligible to enroll into Medicare your less-than-20-employee-small-group-employer policy will likely reject any bills that are sent to them. They’ll want those bills to be sent to Medicare first because “Who wants to pay a bill they don’t have to?”. So in this case if someone is turning 65, still working and their employer has less than 20 employees, they should sign up for Medicare A & B because Medicare is the primary payor. Now, can they still keep their small group insurance plan? Technically yes but one would be wise and factor in the costs of keeping both coverages, in some cases it might be a good idea but it all depends.

So what if my employer has more than 20 employees, should I sign up for Medicare if I’m still going to be covered by my employer health plan? The answer is probably not because you’ll be paying for two insurances that likely won’t save you money on your healthcare bills. If this applies to you, factor how much you’ll be paying for your employer coverage and what sort of cost-share it has (deductible, co-pays, coinsurance etc) when you get treatment. It’s also important to understand what Medicare covers and what it doesn’t. Does it include prescription drugs or do you have to buy it separately?

Other Factors

I did mention that there are other factors to consider, the article “Who Pays Firsts” gives more information but you are welcome to post your questions in the comments, I’ll be happy to answer them. Or if you prefer to contact us directly navigate to our contact section on top.

Here is a link of the article Who Pays First.

Who Pays First


Ask Gabe & Acworth Senior Center Salsa Class Video 2

Check out our second video of our Salsa Class at the North Cobb Acworth Senior Center.

We’ve put together a choreography that almost anyone can learn at their own pace. Stay tuned for future video add-ons as we put these steps in practice when dancing with a partner.

Now go: Practice Practice Practice!

As a reminder we are still in the Medicare Annual Enrollment Period, so make sure that you are reviewing your plan for 2018 before the deadline of December 7th!

Ask Gabe, Inc. Volunteers 6 week Salsa Classes!

That’s right you’ve read it correctly, we are not just business, we like to have some fun too! We’ve partnered with the Acworth North Cobb Senior Center and we are offering a 6 week Salsa Class. Below it’s a video clip of the 1st class. The remaining classes are posted in the Community Section of this website. Come join us!

As always if you are in need of an agent to help you, I’m here for you. It’s the open enrollment period for Medicare Advantage and Prescription Drug plans, so take advantage of my expertise! As always my services are at no cost, nothing to lose but everything to gain!


Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (AEP) BEGINS – What should I do?

It’s that time of the year again where all who have Medicare Advantage Prescription Drug Plans (MAPD) or Prescription Drug Plans (PDP) have the option to review or change their plans for the 2018 plan year. Additionally anyone that has a Medicare Supplement or MediGap policy can review their options and if it makes sense enroll into an MAPD plan and ditch their Supplement (Note that enrolling into a MAPD plan won’t automatically disenroll you from your Supplement plan but it will disenroll you from your PDP plans).

Officially the AEP opens up on October 15th and it lasts until December 7th. During this time you’ll want to make sure that you review the Annual Notice of Change that your current plan sent you explaining what will change for 2018. They are required to send this every year and they normally arrive by the end of September.

So what should I do?

  1. Review the ANOC that you received from your plan, normally it’s a big book containing the policy, member rights, summary of benefits etc.
  2. Carefully compare the changes from the current year to the next. Note that usually the carrier doesn’t list all the changes in the first few pages, they may only list a few. That means that if you really want to know what’s changing you have to dig deeper, so go get your shovel, I’ll wait.
  3. Things you should compare:

    1. Plan Premium (Not to be confused with your Part B Medicare premium, although that can also change annually, there wasn’t an increase for 2018, phew!) The plan may have added a premium or changed it, so take that into consideration. Note that if you get Medicaid and Extra Help the premium could be lower for you.
    2. Check the co-pays for Medical services (Doctors, Hospital, Outpatient Hospital, MRI’s CAT Scans, X-Rays etc).
    3. Check your Prescription co-pays and deductible 
    4. Check that your Medications are still in the formulary (list of drugs the plan covers) and see if they changed tiers. This could change substantially so it’s VERY important.
    5. Review the pharmacy network. Some plans may have Preferred and Standard pharmacy networks, preferred pharmacies will save you money. Example Only: If in 2017 Walgreens was one of the preferred pharmacies make sure that the following year that’s still the case, they could change and you may have to switch to CVS for preferred pricing. Also don’t forget to see if any Mail Order options are available because some plans offer certain drugs tiers at lower or even $0 cost if you get them via Mail Order with a 90 supply.
    6. Review the doctor and hospital Network. Yes you’ll want to make sure that your doctors are still in the provider directory.

Need help reviewing your plan?

Don’t be afraid to consult a professional, they can be a wealth of knowledge and information. Do you know what’s the best part? It doesn’t cost you a dime, yes independent agents are only compensated by the carriers they represent. So if you have an agent make sure that you consult them, if you don’t think they are knowledgeable enough, don’t worry, there are plenty to choose from.

Can Ask Gabe, Inc. help me?

Of course that’s our goal and we will be happy to! We help our clients review their Medicare options each year so they know they are getting the plan the fits their needs. Call or email us and we will schedule a time to talk.

We make it easy for you so you can focus on the things you enjoy most. What we normally do is create a client profile. We save a list of your medications in website (no worries your personal information won’t be tied to it) and every year we will review it with you to see if there are any changes. Using the medication list we match it up with the plans that are available in your area to see which option gives you the best bang for your buck. Additionally we review all the above “Things you should compare”.

We don’t stop there, we even evaluate if you qualify for any programs that could help you save money on prescriptions and medical services. There are substantial savings available for those that qualify.

Give us a call and have piece of mind that you have the right 
coverage for 2018!

Should I sign a Scope of Appointment?

“I need you to sign this before we talk”….

If someone asks you to sign a document before they talk to you about a product, would you want to? My first reaction is to ask “Do you think I was born yesterday”.

That first reaction is understandable, because it doesn’t make sense to sign something before you hear about it. We are constantly told “DON’T SIGN ANYTHING UNTIL YOU KNOW WHAT IT’S ABOUT”. Unfortunately that’s why the document in question has gotten agents a fair share of dial tones, door slams or at minimum a roll of the eyes.

Have you ever been asked to sign a Scope of Appointment? If yes, it’s likely because you were interested in hearing about a Medicare Advantage or a Prescription Drug Plan from a health agent.


So what is it?

Basically it’s a document that gives a sales agent PERMISSION to discuss with clients or prospective clients Medicare Advantage and Prescription Drug Plans.  Oh and that’s assuming you initialed next to the plan types on the form! Yes you read correctly but go ahead read it again. Crazy right? At least that’s what most people think when I explain it to them.

So why would this document be required? It doesn’t make sense!

I agree but it was put in place by the Center of Medicare and Medicaid Services (CMS) years ago to “protect” seniors from unscrupulous sales agents. Yes in the early stages of Medicare Prescription Drug Plans and Medicare Advantage plans many agents were knocking on doors selling “FREE” plans to people they had no business enrolling or at least not without first explaining how they worked. It became a BIG problem, many Medicare beneficiaries were being taken advantage off.

Until recently this document had to be signed 48 hours in advance to a sales appointment. This wait time deterred scrupulous agents from showing up uninvited and enrolling a Medicare beneficiary into a plan. Additionally it prevented agents from doing a bait and switch, basically coming to your home about one thing but with the clear intention of selling you a Medicare Advantage or Prescription Drug Plan instead.

If agents don’t get these forms completed they would receive disciplinary action which could include: not getting compensated for a sale, retraining, losing their contract and even worse losing their insurance license.

So what’s the big deal?

You mean besides that it’s cumbersome, confusing and almost scary? Then nothing.

Just recently I had a client hang up the phone on me because I said I needed a Scope of Appointment signed before I could meet up and discuss a Medicare Advantage plan! While most people don’t react that way there is a considerable amount that get scared away and don’t learn about these products.

If you are Medicare beneficiary should you not sign a Scope of Appointment?

With anything you should first have to consider who is asking you to sign it, one must READ what it says to confirm that it’s legitimate and lastly understand that a Scope of Appointment doesn’t sign you up for anything, it says it right on the document. It just allows the agent to discuss a type of product.

If you are interested in learning about a Medicare Advantage or a Prescription Drug plan, you’ll have to complete a Scope of Appointment (few exceptions apply). Many companies are doing Telephonic Scope of Appointments, this way the process is not cumbersome on paper instead it’s cumbersome over the phone, Ha!

Ok so now that you know what a Scope of Appointment is you’ll at least know that you don’t have to run away. It’s just the rule agents have to abide by to be compliant.


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