Five paths to California health insurance


In California there are essentially five different paths to getting health insurance. Each of the different options have varying conditions and restrictions. Below is a summary of the five paths to California health insurance. There is also a short video you can watch titled California Paths to Health Insurance which also explains the five different […]


Medicare Advantage Plans hit with $2 million in penalties from CMS

Medicare issues $2 million in penalties on Medicare Advantage plans.

Since the beginning of 2015 through April 17th, the Centers for Medicare and Medicaid Services (CMS) have issued over $2 million in penalties on Medicare Advantage plans across the United States. Of the twelve Medicare Advantage plans cited for non-compliance, one had their enrollment activities suspended while the rest were issued civil money penalty. All […]


Chinese Community Health Plan gets immediate Medicare sanctions

Chinese Community Health Plan Medicare Advantage plans sanctioned by Centers for Medicare and Medicaid Services.

On October 29th, 2014, Chinese Community Health Plan (CCHP) was notified that they were being put on immediate imposition of intermediate sanctions from the Centers for Medicare & Medicaid Services (CMS). The Medicare sanction was triggered by what the CMS auditors concluded were severe violations in the Chinese Community Health Plan Medicare Advantage (MA-PD) plans offered in […]


How much does a Medicare Advantage plan really cost?

Medicare reimbursing MA-PDs less in California.

The Centers for Medicare and Medicaid released their reimbursements rates for Medicare Advantage plans by each county in the United States. Commonly known as the capitation rate, the table shows what Medicare pays to a private Medicare Advantage plan each month for each beneficiary enrolled in the health plan. The lowest reimbursement is in San […]


Medicare more expensive than new ACA plans

People face higher costs for health care when they gain Medicare.

Individuals who recently acquired Parts A and Part B of Original Medicare may find they have to pay more per month than their existing ACA health plans. Under the ACA rules, once someone accepts Medicare, they must exit any ACA health plan they purchased through the exchange and the tax credits that make it affordable. […]


Medicare Prescription Drug Plan finder function is great

Medicare plan finder is a great tool for learning about the prescription drug plans.

Before you talk to any insurance agent, prescription drug plan call center or sign up for a Part D Prescription (PDP) drug plan from a direct mail advertisement go to and do a plan comparison. The Medicare prescription drug insurance plans are the most complicated and confusing of all the Medicare decisions a beneficiary must make. The Centers for Medicare and Medicaid Services has built one of the best online comparison tools for evaluating PDPs.


Blue Shield exposes Social Security numbers on public web page

Blue Shield Covered California Binder Payment

Blue Shield of California sent notices to their appointed insurance agents that the agent’s Social Security number had been displayed during the course of member’s online payment. The letter from Blue Shield, dated February 18, notifying agents of the breach to their private personal information does not mention how many agents had their Social Security number’s compromised. While I was not shocked to receive the letter informing me that my personal information was displayed, I was angry that Blue Shield let this happen.


Medicare sanctions CalOptima’s OneCare Special Needs Plan

CalOptima OneCare sanctioned by Medicare.

Orange County Health Authority’s CalOptima OneCare Medicare Advantage plan was served a notice of immediate sanctions by the Centers for Medicare and Medicaid Services (CMS) on January 24, 2014. The immediate sanctions mean that CalOptima can’t market or enroll new members into their OneCare Special Needs Plan until the sanctions are lifted. CMS cited “widespread and systemic failures impacting CalOptima’s enrollees’ ability to access health care services and prescription medications” as a summary for issuing immediate sanctions.


Part D Prescription Deductible Plans verses $0 Deductible

Prescription drug plans with no deductible may cost too much.

One of the first options a Medicare beneficiary faces when they are reviewing Part D Prescription Drug plans (PDP) is whether they want a plan with a deductible. The deductible amount, set by Medicare, is the dollar amount a plan member must pay before he or she is eligible for the reduced copayment for the drugs. The big decision for the Medicare beneficiary is if they should select a PDP with a lower premium and $310 deductible or pay a higher monthly premium for a no deductible plan.


Blue Shield set to acquire GEMCare of Bakersfield

Blue Shield set to acquire GEMCare Health Plan

Blue Shield has introduced a very competitive Medicare Advantage plan in ten select counties through out California. With the acquisition of GEMCare, Blue Shield will be able to more easily offer a version of their Blue Shield 65 Plus HMO plan in the GEMCare service area. While some Medicare Advantage plans seem to be reducing plan benefits and dropping counties, Blue Shield has been selectively increasing their MA-PD footprint in California.