Individual and Family Health Insurance

California Bans Short-Term Insurance

This is a very sore subject with us!  California legislatures BANNED ‘short term’ health plans.  Not regulated them, BANNED them!  Did I wake up in Russia or what?  They are now putting many people in an ridiculously awful situation.  Pay double their mortgage for health insurance premiums or go without ANY kind of health insurance!  How is that serving ‘all the people’?  Short of discussing universal health care (which could take a very long time and we can do another blog about that), we have people that will have serious issues and this needs to be fixed ASAP!  WE NEED HELP! 

We understand what they are trying to do.  If they FORCE everyone into traditional insurance, then the premiums would decrease for everyone.  Sounds good in concept but #1 problem, most healthy young people are choosing NOT to buy traditional insurance and there is pretty much NOTHING we can do about it at this point so everyone’s premiums skyrocketed. #2 problem?  The insurance companies MUST cover pre-existing conditions with no limit.  So if younger, healthy people aren’t getting in and all you have is most sick people, what happens to the premiums?  You don’t have to be a rocket scientist to figure this out.  


Our CA legislatures did not think about certain segments of our population that are being severely punished by their action.  The 1st problematic scenario is this, premiums have doubled or tripled for people that have income over the limits set by the government for a subsidy (financial help from the government with their premiums and/or benefits), the middle class and they cannot afford the premiums any longer.  Many times it’s DOUBLE their mortgage especially in the Los Angeles, San Diego or the San Francisco area.  They would normally be paying through the nose for health insurance premiums ($4,500/mo for a family of four or $1,500/mo for a single person in a Silver PPO plan).  Last year, many decided to go commando and not have any insurance at all.  Enter ‘short term’ plans (some call them skinny plans).  They do not follow ACA guidelines (affectionately known as ObamaCare) and their premiums more affordable than the plans that do follow ACA guidelines.  At least they were covered for some things instead of nothing at all, right?  And yes, just like traditional insurance, some short term plans are better than others.  

The 2nd problematic scenario?  We have a large population of people that are US citizens that live abroad.  They do come back to the US for visits however because they spend 99% of the time in another country, they do not have traditional ACA compliant insurance while living abroad.  We used to be able to pick up a ‘short term’ plan for the couple weeks while they were in CA.  Now, thanks to this legislation, there is NO OPTION FOR THEM EITHER!  So if something medically happens to either of these groups of people, they will have to spend down ALL their assets and possibly declare bankruptcy.  These are good, hard working, middle class people that are being put in an AWFUL position.

We hear ‘experts’ saying that ALL ‘short term’ plans are horrible.  That’s not the case!  Because we pride ourselves on leaving no stone unturned to put our clients in a better health and wealth position, we sourced out some very good short-term plans for clients that would have gone UNINSURED because the premiums were so high for them. 

Here’s the other issue.  Losing a ‘short term’ plan didn’t qualify as a ‘Special Circumstance’ to obtain a regular ACA compliant plan, even if they wanted to go back to one.  So they were left, literally hanging!  So there was a glimmer of good news today (albeit, very small glimmer).  This just released from Covered CA, they will allow a Special Enrollment Period (SEP) for consumers who will be affected by this ban.   They will have 60 days following the last day of their short-term coverage to enroll in a Covered CA health plan.  The last lawful ‘short term’ plan in California will expire on March 31, 2019, therefore the last possible day to enroll in a Covered CA health plan for consumers affected by this ban will be May 30, 2019.

We do have a few solutions remaining so call us if you’re in this predicament too.  And while you’re at it, call your CA State legislator!

Hoffman Insurance Resources is an independent insurance brokerage agency specializing in Medicare and individual/family health plans.  We are contracted with over 40 companies, Covered CA certified and Medicare certified with 13 carriers.  Physically located in the Los Angeles area, we are also contracted in many states throughout the country.  We pride ourselves on doing what’s right for our clients (whether we make money or not), educating you, being your advocate after the sale and exceeding your expectations. We accept only the insurance company commissions so there are NO extra charges for our assistance and guidance.  From ObamaCare through MediCare…we truly Care!  Check out our reviews on Yelp and Google 🙂      323.455.4961



Medicare and ObamaCare (Individual and Family) Annual Open Enrollment

Are you overwhelmed with the ads on TV about your health insurance plan options?  Is your table piling up with mail from every insurance company and agent?  The reason is, it’s Open Enrollment time for Medicare and Individual/Family (affectionately known as ObamaCare).  This is the period where you can switch plans or enroll into a new Part C (Medicare Advantage Plan) and Part D (Part D Plan) OR individual/family health insurance plan.  Here are the dates:

MEDICARE – October 15th – December 7th

INDIVIDUAL/FAMILY – CA, October 15th – January 15th (depending on your State – some are from Nov 1st – Dec 15th)

What to look for?  All plans seem to change something, especially the drug formulary (the list of medications they cover and which Tier they’re covered on). Look at your ANOC (Annual Notice of Change) booklet that you recently received (or call your Plan if you haven’t received it yet).  The first few pages will tell you what is changing in your Plan for the next year. There are also new Plans that are created each year and research needs to be done to see if there is another Plan that may offer you better benefits.   Many Medicare Advantage Plans offer extra benefits like chiropractic, acupuncture, vision, hearing, dental or gym memberships.  If you feel your Plan is good for you next year, there is nothing to do.  It will simply roll over.

Look for the ‘Star Ratings’ of the Medicare Plans also.  Medicare gives an overall rating of the Plan’s quality and performance for the types of services each plan offers.  For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 4 and 5 different categories.  From my experience, there is a reason a Plan gets a low rating so BEWARE!                                         

Medicare uses a 5 Star Rating

This is also the time for those that are uninsurable (maybe in a nursing home or just diagnosed with cancer, etc.) to possibly obtain ‘guaranteed issue‘ into a MediGap supplement plan. If ANY benefit in your Medicare Advantage Plan increased by 15% or was eliminated, a window opens for you to go back to original Medicare (Part A & B) and obtain a MediGap Supplement (with NO insurable questions asked) and a stand alone Part D Plan (for drugs).   With this option, it gives you the choice to see ANY Provider that accepts Medicare, no referral needed!  It comes in handy if you want to go to a skilled nursing facility of your choice or have a surgery from a particular Surgeon.  

If your loved ones or neighbors are on Medicare, please help them.  Many times, they stay on the same Plan because they just don’t know who to turn to.  You can make a huge difference in their lives by having them to call us!

So what’s a person to do?  You can do your own research by going to OR reach out to an independent insurance broker/agent such as ourselves.  Imagine if you could put your head on your pillow tonight, knowing all this was behind you and you knew you made the right choice!  That’s what WE do for you!  We conduct a thorough search and will let you know if your Plan is right one or if you should look at other options.  The icing on the cake…there is no extra charge for our services!  How do we get paid?  If another Plan is better and we’re able to enroll you, we receive a commission from the insurance company.   If you’re on the best plan, we’ll let you know that too!  Make sure the person you are working with is REALLY independent and represents MANY companies.  We have come across many agents that are independent, however they are only Medicare certified with one or two companies :/   At Hoffman Insurance Resources, we are contracted with over 40 companies and Medicare certified with 13 carriers.  YOU’RE best interest is our interest, whether we get compensated or not.  If that wasn’t enough, we’re here for you AFTER we enroll your plan.  We’re your advocate and can help with everything from getting another ID card to helping with a bill you don’t understand.  Check out our Yelp and Google reviews.  Our clients are amazing and very giving  of their stories.  We’re sure one or two will resonate with your situation.  Your only assignment is to reach out to us early because it gets quite busy during the last week of Open Enrollment and our time is extremely limited.  Looking forward to hearing from you!

Hoffman Insurance Resources is an independent insurance brokerage agency specializing in Medicare and individual/family health plans.  We are contracted with over 40 companies, Covered CA certified and Medicare certified with 13 carriers.  Physically located in the Los Angeles area, we are also contracted in many states throughout the country.  We pride ourselves on doing what’s right for our clients (whether we make money or not), educating you, being your advocate after the sale and exceeding your expectations. We accept only the insurance company commissions so there are NO extra charges for our assistance and guidance.  From ObamaCare through MediCare…we truly Care!  Check out our reviews on Yelp and Google 🙂      323.455.4961


Tummy on Fire?

Reading one of my clients blogs, prompted me to expand on this subject since it’s so common. I highly recommend her blog also:

As an insurance agent with hundreds of clients, I hear it almost every day – clients having tummy problems and are taking way too many antacids or the doctors are prescribing proton pump inhibitors (PPI’s).  What I found with most of these clients is, the after effect of eliminating the acid in the stomach seem to cause food to not be digested and nutrients to not be absorbed which then seem to then lead to a multitude of problems and diseases which need more prescription drugs.  Yikes!  It’s like a hamster on a wheel!   I found an extremely effective treatment, and it’s completely natural!  It was sooo simple too…my green drink!  I will say, I’ve educated hundreds of people about this and there are a certain group of people that will ONLY do what their Doctors say and won’t even TRY solving the problem naturally.

Here’s my story, after landing in the hospital in 2014 with diverticulitis (and totally by accident), I found relief for my occasional heartburn (and now many of my clients).   I’m not a Doctor by any stretch of the means however, I wasn’t getting any guidance from the medical community.  They just threw up their hands and said they really don’t know what causes it and to ‘stay away from nuts and seeds’.  What?  I love almonds and berries and they are good for me.  I researched and logically deduced that MY diverticulitis was caused by an acidic and severely inflamed gut.  I needed to adopt anti-inflammatory and alkaline lifestyle but juicing is too cumbersome and expensive (I have no time for that anyway).  My gut needed to be alkalized, not neutralized and I had to find a way to accomplish this, easily and conveniently.  Now, whenever I eat something that causes acid discomfort, I drink 1/2 of my normal green drink.  Within a few minutes, it’s GONE!  And, I’m putting good stuff in my body vs. chemicals.  As a side note, my gums don’t bleed any longer, I’m less bloated and I have more energy than I did in my 20’s!  I also found a green drink with ancient wheat grass and nothing artificial, just amazing nutrients!  Drinking one/day makes me feel incredible along with giving my body the nutrients we sorely lack in our food system today (which will be another blog).   I have told my own Doctors about my story and they just stare at me blankly and go on to another subject.  It’s like they don’t even care about nutrition.  Is this what we’ve come to?  BTW, I still eat berries and almonds almost every day and have NOT had another episode of diverticulitis!


Don’t take my word for it.  Research for yourself!   I highly recommend getting Dave Sandoval’s book, ‘The Green Foods Bible’.  This is what he says about acid:  “Green foods are loaded with an abundance of digestive enzymes, and they promote friendly bacteria and neutralize excess acidity.”  “If you have been relying on an antacid to treat the symptoms of poor digestion, they may have dangerous side effects; they suppress the production of gastric juices for hours at a time, interfering with digestion. Ultimately, the diseases caused by toxic undigested food far exceed the discomfort of gas.  Once again, green foods are the answer.”   My future self is thanking me every day that I found Dave’s book.  I refer to it almost daily for myself and my clients. 

Don’t settle for chemicals if you can solve the problem naturally.  As always, reach out to me if you’d like to learn more about how to live well past 100 or have any insurance questions.  Also, the company that makes my green drink gave me gift cards to share for your initial order.  Let me know if you’d like to try it for yourself! 


Nothing in this article is intended to be medical advice or instructions for medical diagnosis or treatment. If you have, or think you may have, any illness or medical condition, please consult a doctor or other qualified professional. Always seek the advice of a qualified healthcare professional before starting or changing treatment. This article is based on personal experience and research, and no claim is made to accuracy or completeness.

Highlights of the Senate Healthcare Bill

The Senate health bill resembles the House health bill with a couple of changes. I’m sure there will be tons more changes before this passes. Here are some of the highlights:
-Eliminates ObamaCare’s mandate that every American carry insurance.
-The Senate also backs away from some last minute House concessions that would have allowed states to opt out of several protections for those with pre-existing conditions, but insurers would not be allowed to charge higher premiums to those with pre-existing conditions.
-Subsidies will continue for 2 years although they are coming up with a new formula to determine who gets a subsidy and who much. Fewer middle class folks would get help because only those earning up to 350% of the poverty level would qualify, rather than the 400% threshold contained in Obamacare.
-Eliminates the ‘Enhanced’ plan benefits.
-Loosens requirements in Obamacare that health plans all cover a basic set of benefits like no limits on coverage.
-Phases out Medicaid’s expansion program and caps Medicaid (MediCal in CA) spending. It basically puts the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.
-Repeals, retroactively to the beginning of 2016, the “employer mandate,” which requires large employers to offer health insurance to workers or be fined.
-Repeals the 3.8 percent tax on net investment income, to the start of 2017.
-Strips Medicaid funds from Planned Parenthood clinics for one year.
-Health plans that offer abortion services would not be eligible for the subsidies.
The bill is likely to come to the Senate floor next week. They’d like to get it done before the 4th of July recess.
The Senate has 52 seats and the bill would have to pass by 50 with Vice President Mike Pence breaking the tie.  They may have already lost one vote — Senator Rand Paul, Republican of Kentucky, has indicated that the bill is too liberal for him.

Aetna pulls out of the individual market in more states!


This just in from Aetna:  As a result of financial risk and an uncertain outlook for the Individual marketplace, Aetna (including Coventry)  has decided that we will no longer offer individual health products in the following states AR, AZ, CT, FL, GA, IL, KS, KY, LA, ME, MI, MO, NC, OH, PA, SC, TN, TX, UT, and WV for 2018.

What happens when there is no competition? You guessed it!  And we cannot afford anymore prices increases.  I just had another client drop his coverage because he cannot afford the premiums.  He’s 58 years old, makes $31,200/year, lives in a bare bones mobile home and because he worked hard and made a little more money last year, his premium double to over $200/month.  That’s for a Bronze, high deductible plan!

Dear elected officials.  Are you there?  Do you hear us?  HELP!!  We’re drowning!!

Here’s an idea!  Our government should put us all on the same plan our elected officials receive till they fix this mess!

This is killing young healthy women. Spot the warning signs and get help!

To coin a term used for another devastating day in history, June 1st is a day that will live in infamy in my world.  June 1st has always been a very solemn day for me after my hero (my sweet Uncle Leland) lost his battle with lung cancer on this day in 2008.  June 1, 2017 started out the same way. I woke up, said some prayers, thought about our wonderful memories we shared and soon, the day spiraled out of controlled and sent me into a tail spin.  The unfathomable happened, not one but TWO friends received their angel wings that morning.  Both were a shock to my system!  Healthy, beautiful, dynamic women, gone in the blink of an eye.  Lauren (age 69) passed away from an aneurism and Jami (age 47) passed away from a heart attack.  These two women were the picture of health!!  It just wasn’t registering in my brain.   After crying, swearing, questioning and just being numb and lost for a couple of days, I do what I always do and try to make sense out of something so senseless.  What could I do for Jami and Lauren that would turn my sadness into something productive?  It’s my nature to research so I sprung into action, looking for clues in case there was any possible way these could have been avoided.   The first one I tackled was heart attacks in younger women.  What I found left me even more dumbfounded with my jaw dropping to the floor.  This info needs to be shared as quickly as possible and just maybe, we can keep one Mother alive because you shared this blog.

Our story starts with sweet Jami, 47 years old and the mother of two.  An athletic family, they were literally the picture of the perfect family;  Loving, fun, sweet and big hearted Mom and Dad with a daughter and son that were just as talented, smart, loving and beautiful.  For a couple of days, Jami experienced some of the symptoms you’ll read about later in this article.  She laid her head on her pillow one night and went to sleep as usual. Sadly, Jami didn’t wake up the next morning.  Diagnosis, heart attack.  What?  We were all so stunned to hear the news that Jami had a heart attack. After all, she was the picture of health!  Since this just happened recently, I don’t profess to know if this affliction is exactly what transpired with Jami. But what I found in my research was so alarming to me, that I feel a responsibility to spread the word.   Remember this new acronym, ‘SCAD’ otherwise known as ‘the hidden heart attack in young women’.

In the back of my mind, I seem to recall someone talking about how heart attack symptoms are different in women than men.  However, I just never thought of YOUNGER women having heart attacks.  Thankfully, lots of the women I researched, lived to tell their story and see their children grow up, graduate college, get married and even got to enjoy their grandchildren.  Many however, will miss out on those milestones because they just didn’t know what they didn’t know.   We’re so good at chalking how we feel up to a myriad of issues…the flu, stress, a virus, vertigo.  Please, think twice about it next time that happens to you or someone you love.  Check out this story from is a great example from a 33 year old young mother:

Meghan Scheiber was in the middle of a 60-hour workweek when the call came: her 2-year-old son was sick at day care and needed to be taken home.  Buried in work and deadlines at her medical billing job, Scheiber was already feeling stressed. As she worried about how to juggle everything, she suddenly felt like she was going to pass out and had a heavy feeling in her chest and arms. She chalked it up to an anxiety attack or the start of the flu, let her husband pick up their son, and finished her workday before driving home.  But when the heavy feeling came back the next day at home, Scheiber, knew she had to act. “I said to my husband, ‘We have to go to the ER.’”  By the time she got there, she was in the middle of a heart attack.  She was admitted to the intensive care unit and had a second heart attack 2 days later.  Doctors diagnosed Scheiber with a type of heart attack often found in younger women. It’s called spontaneous coronary artery dissection, or SCAD.  “I asked my doctor if I would die,” she recalls tearfully 6 years later, “and he said he didn’t know what would happen.”

“SCAD isn’t rare. It’s rare to meet a survivor.”

That quote from the SCAD Alliance website spoke to me in a not so good, haunting voice.  I found out that sadly, many emergency facilities do not even check for SCAD because it only causes a small percentage of heart attacks overall (at least that’s what they thought).  Yet, SCAD seems to be responsible for 40% of heart attacks in women under the age of 50.  And it’s mostly happening to young women — more than 90% of SCAD patients are female.   In story after story, the hospital sent these young women home, telling them to take an over the counter pain relief medication.   But in my book, when it’s your daughter, wife or mother, that small percentage takes on a whole new meaning!  The other thing that amazed me is this affliction has only been studied for the LAST 5 YEARS!   Wow, in this day and age of medical advancements, that really blew my mind!

In some instances, there is nothing that could have been done.  However, in many cases, there are advance symptoms, many of which we could chalk up to some other affliction like the flu, a virus or vertigo.  So hear is the low down:  Unlike a more typical heart attack caused by a buildup of plaque in the arteries, a SCAD heart attack starts with a tear in an artery.  The tear blocks the artery and blood flow to the heart, leading to a heart attack. (Check out this video from the Mayo Clinic.).  According to many sites, many women experience varying symptoms including:

  • Shortness of breath, with or without chest discomfort
  • Heaviness in the chest
  • Breaking out in a cold sweat, dizziness, nausea or lightheadedness
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach

It’s very easy to see why many women would not even pay attention to dizziness, nausea and lightheadedness and attribute it to everyday illnesses or stress.

Our hearts are heavy and we still can’t imagine a world without Jami.  Even though SCAD may not have been what took our Jami, now that you are aware, spread the word and let every person in your life know if they experience any of these symptoms, get to an ER ASAP and be vocal about checking for SCAD.  If it’s really the flu or stress, you’re just out a little bit of money for the ER.  I’m sure there are many husbands, daughters and Moms and Dads that would gladly pay a few hundred dollars to have their loved one back in their arms.  By reading this and being that nagging voice of reasoning to your friends/family, you could possibly save a loved one or better yet, YOURSELF.   Please share this with your friends, family, daughters, mothers and sisters.  Do it for Jami!



SCAD Alliance Website

Mayo Clinic – SCAD Heart Attacks

FOX 8 Article




Debbie Hoffman is an independent insurance broker specializing in Medicare and individual/family health plans, contracted with over 40 companies, Covered CA certified and Medicare certified with 13 carriers.  Located in the Los Angeles area, she is contracted in many states throughout the country.  She prides herself on educating her clients, being their advocate and exceeding their expectations.  She accepts only the insurance company commissions so there are no extra charges for her assistance and guidance.  From ObamaCare through MediCare…Debbie cares which is why she educates the public on health issues she encounters.  Her goal is help everyone live longer, healthier lives!    323.455.4961

On Covered CA and getting a subsidy on your health insurance? BE AWARE!

Opening your mail as you normally do and to your surprise, there’s a letter from Covered CA saying ‘Congratulations, you’re eligible for MediCal’!  Well, in all fairness, they don’t actually say ‘Congratulations’ but you get the gist.  This is what is transpiring right now as thousands of Californians that receive a subsidy, are getting pushed into MediCal because their income on their Covered CA account is $1 too low.  Yes, you read that correctly.  If you are $1 off, you too could lose your doctor!

Why?  The government released the 2017 Federal Poverty Limit Chart that gives guidance to which plans you are eligible for based on your MAGI (modified adjusted gross income) that you reported in Covered CA.  Why they don’t release this at year end, we’ll never know.  That would make too much sense!  For most people, your MAGI is Line 37 on your personal tax return.  If you receive social security and/or tax exempt interest, that’s added to your AGI to come up with your MAGI also.  If that figure is off by $1, instead of that amazing Silver 94 plan you’re enjoying, you could get that wonderful letter saying ‘Welcome to MediCal’.  Or if your MAGI is $1 to high, you could be pushed from the wonderful Silver 87 plan to the not so great Silver 73 plan (HUGE difference in benefits!).  It is vitally important that you check your Covered CA account, look at what income is reported to see if you are in danger and if so, get it changed asap!  I would even go so far as building a buffer for when it’s increased next year.

This mostly affects self employed people because you’re able to write off expenses from your income.  And the income in your Covered CA account is a guess-ti-mate anyway because how on earth are we supposed to predict the future?  I’m sure your tax person could find an extra dollar or two.  And if they can’t, we’ll get you to someone that can!  Are you making too much money?   Did you know that you could put money into an IRA or 401(k) and that would lower your MAGI?  And if you’re self employed, always make sure your tax pro is deducting your health insurance.

Here’s an idea!  Would you rather have someone deal with this for you and not have to pay them any extra?  It’s your lucky day!  While Covered CA really doesn’t advertise it very well on their website (not sure why), you can have an advocate on your side to take care of things like this and it doesn’t cost you ANYTHING extra!  You’re read that right, you won’t pay one extra dime to have us keep up with things like this AND MUCH MORE!   We accept just what the insurance companies pay us.  If you already have an agent and they aren’t pro-active like we are, while they may be really nice, it’s time to change agents!  Once we find out that Covered CA is utilizing the new chart, we review each account to see if they are in danger.  If Covered CA has to be called or your case needs to be appealed, we do that for you. We’re that breathe of fresh you’ve been looking for 🙂

Call or email us and we’ll walk you through how to easily add us as your advocate on your Covered CA account or your ‘off exchange’ health insurance plans.

Debbie Hoffman, Insurance Designs



Avoiding Medicare Part B Penalty, Part 1 – Medicare Eligible and Covered Under an Employer Group Plan

Welcome and thank you for reading my very first blog!  I’m extremely honored and grateful you chose to spend a few minutes of your time with me.   My goal is to bring something valuable to your life that will put you in a better health and wealth position AND make confusing subjects, easier to understand.  One of the most disheartening parts of our job as an independent insurance agent is to give bad news to a client and not being able to do anything about it.  From our vast experience, I’d like to use this blog to help you avoid some of the ‘gotchas’, pitfalls and crazy rules that could get you in a pickle later.    

If you hadn’t noticed, Medicare can be very confusing.  There are some really quirky rules in Medicare and this is one of the craziest.  It’s relatively easy to enroll into Medicare when you turn 65 and your situation is pretty straight forward.  However, if you have something out of the ordinary, you need to know the rules so you won’t get penalized in the future.  This has popped up a few times in my career so it’s good to realize it’s a problem in case you know of anyone that fits the situation. You don’t have to know ALL the rules, you just have to be aware it could be a problem and know where to seek guidance.  Unfortunately, many of Social Security’s own staff do not understand this rule.  It has to do when do you apply for Part B if you are covered under an employer group plan.  The rule (from is you can delay Part B (and avoid the penalty) if:

  • You have insurance through an employer or union.
  • You or your spouse (or family member if you’re disabled) are still working.

Notice the 2nd part of the rule…’still working‘.  That’s the part most people miss.  But wait…there’s more!  In addition to being penalized, you cannot apply for Part B at just anytime of the year unless you have a ‘special circumstance’.  This situation does NOT fall under one of their ‘special circumstances’ and therefore you can ONLY apply during the Part B Open Enrollment which is from January 1 – March 31st.  But wait…there’s even more!!  Your Part B won’t become effective until July 1st!

Here are a couple of stories that illustrate the problem:

  1.  Betty retires at age 60, her spouse, Bob, is 65.  Part of her School District’s contract with the union covers her for insurance till she turns 65.  That’s normally a great benefit, UNLESS your spouse is eligible for Medicare!  In this case, Bob delays Part B because he is still covered under the group plan.  When she turns 65, they both go into their local Social Security to apply for Part B where they are informed Bob will have to pay a penalty because he did NOT obtain Part B when she ‘stopped working’. The Part B penalty is 10% for each year he didn’t have the Part B = 50% of the current Part B premium!  For 2017, the Part B premium is $134, therefore, he pays an additional $67/month…FOREVER!  AND it will increase as the Part B premiums increase.

AVOIDING THE PENALTY:  When Betty retired at age 60, Bob should have applied for his Part B at that time. 

  1. Susan, age 64, has an accident at work and goes onto worker’s compensation.  When she turns 65 (even though she isn’t technically working), her company continues to keep her on the employer group plan.  At that time, she goes to her local Social Security office where she meets with an agent and is upfront, informing the agent that she is out on disability but still covered under her group plan.  The Social Security agent tells her that she can delay her Part B.  After 2 years of being on disability, the employer group plan stops.  She goes back to the Social Security office and they inform her that she will be penalized 20% for 2 years of not having Part B when she was eligible.  The good news is she kept VERY good notes, recorded the date/time and name of the agent.  This is IMPORTANT because everything is video recorded at the SS office and they can look back at the recordings to verify her story.  Because it was a Social Security agent that misinformed her, she is currently appealing through Medicare (we’ll discuss appeals in another blog).  My thought is she will have the penalty reversed because she kept good notes and SS misinformed her.

AVOIDING THE PENALTY:  When Betty turned age 65, she should have applied for his Part B at that time. 

So think about it, if Bob or Susan tried to apply for their Part B on April 1st, they have to wait till January 1st of the NEXT year AND they won’t have coverage till July 1st of the NEXT year.  Yikes!  That means they will have to go without doctor/out patient medical coverage for 1 year and 3 months or have to purchase an individual plan at exorbitant rates because they are over age 65 (ESPECIALLY during ObamaCare).   In my opinion, this is insane and should be changed!

In summary, keep excellent notes when you speak with Social Security or Medicare.  Record the date, time and everyone’s name you speak with!   I also suggest asking different agents the same question to see if their answers coincide.  If possible, obtain something in writing.  AND hold onto to that info FOREVER!


Debbie Hoffman is an independent insurance broker specializing in Medicare and individual/family health plans, contracted with over 40 companies and Medicare certified with 13 carriers.  Located in the Los Angeles area, she is contracted in many states throughout the country.  She prides herself on educating her clients, being their advocate and exceeding their expectations.  She accepts only the insurance company commissions so there are no extra charges for her assistance and guidance.  From ObamaCare through MediCare…Debbie cares.    323.455.4961