2017  Donut Hole

What Happens in 2017?

As per the government’s plan, the donut hole has closed slightly in 2017 compared to the previous year. In 2016, the coverage gap began at $3,314, but it has now increased to $3,700. This is good news because your plan will pay more towards the cost of your prescription medication before you reach the donut hole.

In addition, the percentage you have to pay for your drugs while in the donut hole has decreased in 2017. In 2016, seniors had to pay 45 percent of the cost of brand name drugs and 58 percent of the cost of generic drugs. In 2017, you will pay 40 percent of the cost of brand name medication and 51 percent of the expense of generic medication. By 2020, you will only have to pay 25 percent of the price of both brand name and generic drugs in the donut hole.

In 2017, 95 percent of the price of brand name drugs will count towards your out-of-pocket costs. The plan pays 5 percent of the drug cost and 55 percent of the dispensing fee; neither figure counts toward your out-of-pocket spending.

Here are a couple of examples of donut hole costs in action using brand name and generic drugs.

Volunteers Needed

Volunteer for the Senior Medicare Patrol. The Senior Medicare Patrol (SMP) is a group of highly trained volunteers who teach about Medicare health care fraud. Senior Medicare Patrol volunteers show Medicare and Medicaid recipients how to protect against, detect and report many types of Medicare fraud. Senior Medicare Patrol Volunteers serve at least 8 hours a month. They must first complete 30 hours of Medicare training and 20 hours of internship to be able to become a Certified Health Insurance Counseling & Advocacy Program (HICAP) Volunteer Counselor. They also complete an additional 2 hours of SMP training in Medicare fraud. Monthly SMP webinars are also available for the needed continued training and updates on current fraud issues. As ObamaCare kicked into full gear in 2014, the enrollment dates are the same as Medicare Advantage Plans and Part D Drug Plans, October 15 - December 07 2013. HICAP needs MANY Senior volunteer counselors for that busy and confusing time. 

The Fresno office will not work will Insurance Agents or Insurance Brokers, but I believe they need MANY more volunteer counselors. 

HICAP: Fresno County
3845 N. Clark, Ste. 201
Fresno, CA 93726  
(559) 224-9117

​More information: http://valleycrc.org

SSI Benefit Increase

Social Security Finally Announces 0.3 Percent Benefit Increase for 2017! Monthly Social Security and Supplemental Security Income (SSI) benefits for nearly 65 million Americans will increase 0.3 percent in 2017, the Social Security Administration announced today. The 0.3 percent cost-of-living adjustment (COLA) will begin with benefits that more than 56 million Social Security beneficiaries receive in January 2017.  

Enrollment Dates

Annual Enrollment Dates CHANGED in the Fall of 2011. There is only one time a year for 6 weeks that you can change and enroll into a different Medicare Advantage Plan or Part D prescription Drug Plan.  This time is called - The Annual Enrollment Dates.  The new Annual Enrollment dates begin in the FALL of 2011. The NEW Annual Enrollment will be from October 15th - December 7th. This will allow more time for processing your ID cards before the new year of January 1. 

New Law

A new law protects seniors! The Dodd-Frank Wall Street Reform and Consumer Protection Act was signed into law on July 21, giving priority status to the protection of consumers from predatory practices. With one out of every five people age 65 or older victimized by money-related crimes or questionable financial practices, the new law is especially beneficial to seniors. The house bill would teach seniors about scams and scam artists.  H.R. 3040 would authorize $50 million over the next five years for the Federal Trade Commission to help seniors learn about financial fraud through educational programs and a new website. The measure passed 335 to 81.  .

Victory for Seniors

This just in...from the Center for Medicare Advocacy  Finally after YEARS of Insanity, a Victory for seniors!!! The Improvement Standard Settlement is a settlement in the class action lawsuit brought against the Secretary of Health and Human Services, Kathleen Sebelius, to eliminate the policy and practice of the illegal, harmful and unfair Medicare "Improvement Standard." 

The Improvement Standard has harmed thousands of older and disabled Medicare beneficiaries who need Skilled Nursing Facility care to maintain their conditions, but who have been denied coverage on the grounds that they are "not improving". A settlement has been reached and will create a smoother road for beneficiaries to receive the health care they need.

​CMS will revise the Medicare Benefit Policy Manual and other Medicare Manuals to correct suggestions that coverage is dependent on a beneficiary "improving," and add provisions stating that skilled services necessary to maintain a person's condition can be covered by Medicare. 

​After the policy revisions are completed, CMS will conduct an education campaign to inform providers, Medicare decision-makers, and adjudicators of the new skilled maintenance provisions. 


BE ADVISED: There are many scams going on right now from people calling seniors saying they are from Medicare or an Insurance Company trying to get your Medicare Number. They know that your Medicare number is a social security number. They can cause great financial hardship for you if they have your social security number and can steal your identity.  Make sure you get the phone number of the person claiming to be from Medicare or Insurance Company so that Medicare can deal with the situation. 



Call Me Today!



- Professional Health Insurance of Advanced Studies

New CA Website

New California Website for seniors:     www.seniors.ca.gov. The Senior Gateway website is intended to provide seniors, their families, and caregivers with information they need to connect to services and resources, to find answers and solve problems. Information on such topics as: 
Avoiding and Reporting Abuse & Neglect
Preventing Fraud
Financial Abuse & Common Scams
Health Care Information
Your Rights
Other Resources


New Plastic Medicare Cards starting in April 2018 ~April 2020 Beware of Internet and Phone Scams NOW
Have you heard you’ll be getting a new Medicare card? Wondering when or why? This isn’t happening until April 2018 but scammers are already jumping on the confusion as an opportunity for fraud. That’s why we’re sharing some facts.


Due to Congress passing the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, the Centers for Medicare and Medicaid Services (CMS) is required to remove Social Security numbers from all Medicare cards. This process will start in April 2018 and end no later than April 2019. This is referred to as the Social Security Number Removal Initiative (SSNRI). New Medicare cards will be issued with randomly assigned 11 characters made up of numbers and digits. These 11 characters will be your new Medicare Beneficiary Identifier (MBI).

This change is to help prevent fraud and protect your identity. Currently, most people’s Social Security number is their Medicare number, which makes collecting Medicare numbers an easy target for scammers to steal your identity, open new credit cards or take out loans in your name. The new MBI, however, will not be tied to your Social Security number and is therefore more secure.

CMS will start mailing the new cards in April 2018., but it could take 2 years. CMS has already started educating providers who need time to update their systems for these new identification numbers.

So how may scammers use this change to their advantage? They prey on any confusion. Some scammers call beneficiaries claiming to be Medicare and say they must confirm their current Medicare numbers before sending them a new card. Others call saying there is a charge for the new card and are collecting beneficiaries’ personal information. There is no charge for your new card and Medicare will never call you for your information. They already have it.

If you receive any such calls or suspicious solicitations, hang up and call the Senior Medicare Patrol at 1-855-613-7080.