In the recent Arizona 8th Congressional District debate, Republican Jesse Kelly came across as a moderate. When Kelly finished his list of what the American people need with regards to health insurance, I said to myself, “That sounds like Obamacare!”

Jesse Kelly said people should be able to buy health insurance across state lines. The Affordable Care Act allows states to form compacts for the interstate sale of insurance.

Jesse Kelly said businesses should be able to get together and buy one “blanket plan”, so their health insurance costs would be lower as a large group. His proposal is more restrictive than Obamacare because, under Obamacare, multiple plans will be listed on each state exchange. Small businesses and individuals will be able to select a plan that fits their needs. Because of the exchange, these small businesses and individuals will be part of a big group, resulting in lower premium costs and multiple plan options.

Jesse Kelly said people should get tax breaks for their health insurance costs, just like businesses. Obamacare provides tax breaks for everybody (below a certain income level) who buys health insurance.

Jesse Kelly said people should not have to be worried about losing their health insurance if they lose their job. Under Obamacare, people will not be dependent on their employer for their health insurance because they will never be denied coverage due to a pre-existing condition.

Listening to Jesse Kelly’s debate comments, two things come to mind: 1) He doesn’t know what’s in the Affordable Care Act, or 2) He agrees with some of the most important parts of Obamacare. I suppose he is against the mandate, despite the fact that this was originally a Republican idea promoted by Newt Gingrich, John McCain and, of course, Mitt Romney in his Massachusetts health insurance program.

I give Jesse Kelly credit for having a well-thought-out and well-rehearsed presentation on his plan for health insurance reform. Ron Barber needs to beef up his response to questions about his position on the Affordable Care Act. Why didn’t he say to Kelly, “Hey, guy, what you just said about your plan for fixing  the problem is Obamacare!”?

I would have liked to see Ron Barber run through the long list of good things in Obamacare. Then he should have asked Jesse Kelly which ones he would keep and which ones he would eliminate. Of course, Kelly wants to repeal the entire Affordable Care Act, which makes him extreme rather than moderate, in my opinion.

Here is a video clip of Jesse Kelly’s solution for our current health insurance problem:

In the last two weeks, I have talked to several people who delayed enrollment in Medicare Part B because they were working beyond their 65th birthday or were covered by their spouse’s employer health insurance. Every one of them was a bit confused about what they needed to do to get Part B.

Steps to take to get Part B:

If people plan ahead, they can take care of their delayed enrollment in Part B by mail. But everybody I have spoken with waited until the last minute and wanted their coverage to begin on the first of the next month. So they needed to move quickly to get their paperwork in order.

Katherine, who is 66, called Social Security to tell them she wants her Part B to begin on June 1st. She asked about getting the necessary paperwork on-line and was told the forms are not on the Social Security website. (I wonder why?) She was told to google the following:

CMS-40B     This form is used to apply for Part B using a special enrollment period.

CMS-L564   This form must be signed by the person’s employer to certify that he/she has had employer group health insurance.

These two completed forms can be taken to the local Social Security office, and the enrollment in Part B can be in the system in just a day or two. It’s a good idea to call Social Security (800-772-1213) to see if you can make an appointment at the local office. When talking to Social Security, ask if  there are any other documents you need to provide. I have heard of some people being required to provide a birth certificate.

When I talked to Connie, who is 66 and just quit work, she asked me to email her the two forms mentioned above.  When she called Social Security to make an appointment at the Tucson office (3500 N Campbell), she was told she would have to go into the local office, take a number, and wait her turn.

Part B is required to apply for Medicare Advantage or Medigap.

A person cannot submit an application for Medicare Advantage or Medigap until their Part B is in the system. Last month I worked with Fred, who waited until Monday, April 23rd to submit his forms to Social Security. Two days later, we sent in an application for  a Medicare Advantage plan with a start date of May 1. I was worried the application would be rejected because his Medicare record would not show he had Part B.  My fears were unfounded because he was in the system – just two days after submitting his paperwork for Part B.

Medicare Advantage: When a person has delayed enrollment in Part B because he had employer health coverage, a specific code must be put on the Medicare Advantage application. If the wrong code is used, Medicare will reject the application. (Note to new insurance agents: This is not an IEP or ICEP.)

Medigap: A person who has had employer health coverage can get a Medicare supplement with “guaranteed issue”, no matter what his age or what health problems he has.  The Medigap application has some confusing questions that actually pertain to guaranteed issue. (Experienced insurance agents know what I’m talking about.)

I have been pleasantly surprised at how efficiently the local Social Security office performed for people who waited until the last moment to submit their paperwork for Medicare Part B.  If a person takes care of this two months before they want Part B to begin, they can receive and submit their paperwork by mail. But it seems like a lot of people are not aware of what they need to do to get their Part B started if they delayed enrollment for good reasons.

I have been contacted by several clients who received phone calls from their Medicare Advantage plan saying the plan would like to send a doctor to their home to give them a physical exam.  My clients called me to ask if this was legitimate. Or was it a scam?

Mindy called to say her Advantage plan is “bugging” her about letting their doctor come to her house.  “My plan is really pissing me off about this”,  she told me. She said they call her once a month to ask the same question, and each time she gives them the same answer: “No thanks”.

Mindy said a friend of hers, who is 90 years old, agreed to a visit by her Advantage plan’s doctor. The visit went just fine. The doctor was accompanied by a nurse, and they took her blood pressure and asked lots of questions.  Then they checked this lady’s home to see if there were rugs or other items that might put her at risk of tripping and falling.

Soon after the visit, this lady’s Advantage plan gave her a list of tests they think she should get. The lady took the list to her primary care doctor who poo-pooed it and said the Advantage plan should butt out of this lady’s business.  I guess doctors don’t like insurance companies getting in between them and their patients, even if the insurance company is trying to be of help.

It’s about money.

The reason Medicare Advantage (MA) plans are sending doctors and nurses to people’s homes has to do with getting more money from Medicare.  Medicare pays Arizona Advantage plans around $800 per month for each person enrolled with them. However, MA plans get more money for sicker members.  This is called “risk adjustment”, and it is very important since MA plans are now being paid a lower base rate than they were a few years ago. MA plans can get more money up front if they are able to identify members with serious health issues like diabetes and heart conditions, and this is the reason for the house calls.

It’s about stars.

The house calls are also about the Medicare star rating system.  The ratings go from one to five stars and are based on more than 30 criteria such as:  surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get preventive screening tests and flu shots.

Most of the Medicare Advantage plans in Arizona get 3 to 3.5 stars, meaning they are average. The more stars a plan gets, the more bonus money it receives from Medicare. One plan in Tucson got four stars this year. In Phoenix, Cigna gets 4.5 stars. The plans have until 2014 to get to 4 stars and keep getting bonus money from Medicare.

Is it political?

Some people are calling the star rating bonus program “Obama’s Medicare slush fund“, and I wrote about it recently.

Over 45% of Medicare beneficiaries in Tucson, Phoenix, and Pinal County are enrolled in Medicare Advantage plans.  But they are not accustomed to their plan reaching out to them and asking to come over for a visit. This outreach is confusing for some. It is a bit scary for others. And in Mindy’s case, she is  pissed off by her plan.  I’m sure there are many people who think the doctor visits are a good idea. I just haven’t heard from them.