Capistrano Financial & Insurance Services - Blog

Capistrano Financial & Insurance Services

Happy Summer time

8/8/2019

I wanted to share a lot of great Medicare information that I am coming across in my renewal training they put agents through every year.

For those of you on a Medicare Supplement "F" plan, there is an alternative plan called the "G" plan, which saves some money with almost identical benefits. And for those that are on the F plan, there is a relatively new plan called the F Extra that has a couple of more benefits like vision & hearing discounts, personal emergency response system. Call me if you would like to know more about either plan.

Exciting news for Scan members. All Costco stores in every county in Scan's service areas are available for the purchase of Frames and Lenses, even if you don't have a membership.

If you have not done so by now, you should go to www.mymedicare.gov and register. You will need your Medicare ID number. I am told you will be able print your Medicare card if need be, view claims information, and more.

I'm hearing there might be even more health benefits coming out. I even heard pest control for people with chronic health conditions.

And for the most recent newsletter on the market from my investments partner Alan, click on the link below. Or I can send it to you by an email if you request it. Call or email if you would like to have your portfolio analyzed or a portion of it managed in this up and down market.
Click newsletter

One of my Medicare clients just came out with an easy-to-read book called "Right to the Soul." I bought it and have really enjoyed it. It's short inspirational stories. If you wonder who God is, or if miracles are real, then read it. It can be life changing. Also, a unique flip story and art. I read one story a day and let it soak in. A great way to start the day!
You can read more about it and buy it here- https://righttothesoul.org/

Let me know how you are doing. I love hearing from you.

Thank you!
Darrell Fryer
Direct 949-248-3112

April 23rd, 2019

4/23/2019

I hope things are going well for you in springtime, looking forward to summer. I wanted to touch base and share a couple of things that perhaps you were not aware of in my line of work.

1. I often have auto or homeowners clients call me about filing a claim which is great. Often it's a claim when the estimated damage is around what their deductible is at or slightly more. A claim is a claim regardless how small it is. If you have one claim on record in past 3 years, that's OK. However, two hurts and three really hurts. You might get dropped or will pay a higher price and the number of carriers we can shop it to is greatly reduced. Therefore, avoid filing a claim unless it's worth it. If it's NOT your fault in an accident, then you're OK. I have fixed about 20 leaks with my house over the years by calling the plumber or leak detection services who have always fixed it with minimal cost. With YouTube and Home Depot, I've even gotten good at drywall repair. Also, if your going out of town for a weekend or more, turn off the main water which is a simple valve usually in the garage.

2. Medicare does not pay for a routine yearly physical. Medicare pays for two wellness visits: a one-time Welcome to Medicare Visit and an annual Wellness Visit.
An annual physical is a much more extensive examination than the Welcome to Medicare Visit or Annual Wellness Visit. In addition to collecting a medical history, it may also include a vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam.

I had a client who got a surprise bill for a physical and the doctor's office never explained Medicare doesn't cover it. They should have done a Wellness visit, not a physical. He didn't pay it and fought it for not being told prior that it wasn't covered and the office withdrew the bill. Furthermore, he was a terminal patient of the doctor and I can't understand why a "physical " was done in the first place!! It never hurts to ask if the service or test is covered before having it done.
3. A lot of my clients and friends tell me they like my partner's market insights newsletter. It's great information on the market and what is going on. Go to my website at capistranoinsurance.com/investments to read it. Scroll to the bottom of the web page and click on the "Market Update Newsletter" update. The market is impossible to predict so why not have a professional do it for you? Even if your just starting out, no problem. And your account is held at Fidelity Investments.
Let me know if you would like to setup a call with my partner Alan and myself.
Call me at 949-248-3112 if you have any questions.
Blessings,
Darrell

What do these auto terms mean?

6/23/2017

The biggest mistake I see from people is they really don't understand what their coverages mean and what exactly is at stake by not being informed. So here's some info just in case. Keep in mind that if you cause an accident, and suffer a significant judgment against you, damages over and above your policy limits will be your responsibility. That means your personal assets and even your future earnings could be at risk. There are generally six different types of auto insurance coverage. Bodily injury and property damage liability pays for your legal defense costs and judgments against you in cases that involve injuries or damage to other people or property. Often I see someone having 15-25,000 property damage. There are a lot of cars on the road in CA that are over 25,000!!! Medical payments coverage pays for the medical expenses of the insured driver and passengers, regardless of fault. Uninsured/underinsured motorist covers losses caused by a driver who is uninsured or has inadequate insurance. Collision pays for accident damage to your own car, while comprehensive insures your vehicle against all other physical damage — including those that result from theft, vandalism or natural disaster. Drivers may also purchase endorsements that extend their coverage even further. Rental reimbursement will pay for a rental car while your damaged vehicle is in the shop. Optional towing and labor insurance kicks in whenever your auto breaks down — not just for accidents covered under the basic insurance. The other mistakes I see are in policy limits. They are the maximum dollar amounts that will be paid by your insurance company in the event of a claim. There are separate limits set for each type of coverage, and higher limits will require higher premiums. Consider the value of your vehicle and personal assets, your tolerance for risk, and the amount you can afford to pay out of pocket when you choose your coverage limits. Last, I want you to know I don't just handle auto/homeowners plans. I handle ALL financial and insurance services. I do a lot of retirement planning such as investments with mutual funds, ETF's, etc. Most Americans are not prepared at all for college funds/retirement and please don't rely on social security to be there. It is not nearly enough to survive on. Put something away every month so you can get dollar cost averaging working in your favor in up and down markets. If you make a retirement account just like you do for all your other bills, you will be shocked at how it grows over time. Call me and we can discuss setting something up and getting you started

My You Never Know Moment

8/17/2016

I just got out of a 10 day lovely hospital stay and I wanted you to know about this because it's a "you never know" situation. Out of nowhere, I got struck with a rare condition called Trigeminal Neuralgia. If you google it, you will see it's nasty. It's the nerves effecting the face, such as eyes, mouth, and ears. In my case it was my right eye. It's a stabbing pain or electrical shock of the most excruciating pain. The scary part is there is no known cure other than drugs and surgery which are not always successful. I'll take any prayers that the drugs work. The reason I am telling you this is because I will never be able to apply for life or long-term care coverage because it's an automatic decline. Fortunately, being in the business, I have those coverages in place and all set. So, stop and think, if you have a life policy, let me review it. In order for me to replace it, I have to prove to the new carrier how the new one is better. Perhaps we can add more years if you have a term policy. If you have a universal/whole life policy, many I review will blow up in much higher premiums down the road. Maybe you have no coverage, would your dependents be ok if you passed away? You can even get a burial guaranteed issue policy of $5-20,000, very inexpensive, so your loved ones don't have to deal with it when that day comes. If you have a long-term care policy, I salute you! Smart move. Leave that alone. Maybe you got that policy a long time ago and could use a little more coverage for care. We could add another small one. You need at least $5-6,000 per month for care. If you don't have any coverage, if you need care today, what is your plan? Clients and customers who call me for this are ones who have seen it with their family and the toll it takes.
So, take a minute and give it some serious thought. I don't mean to be "salesy" but it's real life and you never know. I wouldn't be doing my job if something happened to you and you said to me, " I didn't know about that or I didn't think about it".
Thank you,
Darrell Fryer

The Scoop On Dental Plans

10/12/2015

Brushing and flossing are key to your dental health. So is choosing the right dental coverage.
While dental insurance doesn’t command the attention that medical insurance does, it also can have significant implications for your pocketbook.
You know exactly what I mean if you have the most common type of health insurance (more on that later) and have ever needed a procedure such as a crown or root canal.
Read: $$$$
More than 19 million Californians had commercial dental insurance in 2014, and most of them obtained it through their employers, according to the National Association of Dental Plans (NADP).
But “in a way, it shouldn’t even be called insurance,” says Jeff Album, a vice president at Delta Dental, California’s largest dental insurer.
Album prefers calling it “a prepaid plan” for preventive and basic services, such as cleanings and fillings.
If you need a more complicated procedure, “you’re going to end up paying a big part of the bill out of pocket,” he says.
Today I’m offering five tips on how to best use your dental benefits to save you money and frustration.
CHOOSE THE RIGHT PLAN
There are two primary types of dental plans: HMOs and PPOs.
The vast majority of Californians with commercial dental coverage — more than 14 million — have PPOs, the NADP says.
Here’s how a dental PPO works:

In addition to your monthly premiums, you may owe a deductible before your insurance kicks in. Deductibles typically are under $50 and generally aren’t applied to preventive services, Album says.
You face annual limits on your coverage, typically between $1,000 and $2,000, which is the maximum your insurance will pay out in one year.
Twice-yearly cleanings and other preventive services are usually fully covered. You’ll pay a percentage of the cost for other services, such as 20 percent for a filling or 50 percent for a crown. Which adds up fast.
A dental HMO operates differently.

Your premiums will be lower.
You probably won’t have deductibles or benefit maximums.
You’ll pay fixed copayments for treatments.
However, with an HMO, “your choices of dentists is much, much smaller,” Album says.
How much smaller? About 90 percent of California’s practicing dentists participate in PPOs, whereas about one quarter participate in HMOs, the NADP says.
You may also have fewer treatment options with an HMO, says Long Beach dentist Gary Glasband. For example, an HMO may agree to cover a metal crown. But if you prefer a ceramic crown that blends in with your other teeth, you may have to pay an additional cost, he says.
“You’re going to look at this choice differently if you’re a 20-year-old who has very little dental needs compared to someone who needs complex work,” he says.
If you have children, consider whether the plan covers orthodontic benefits, Glasband adds.
Once you’ve chosen your plan, understand your coverage. For instance, if your plan covers two cleanings a year, can they occur at any time or do they have to be more than six months apart?
“One cleaning every six months is not the same as two cleanings a year,” Glasband says.
STAY IN NETWORK
You will spend the least amount out of pocket by staying in your dental plan’s network, whether you have an HMO or a PPO.
With an HMO, you usually won’t receive any coverage out of network.
In the case of a PPO, you will receive the highest level of coverage from an in-network dentist plus reduced rates on the amount you have to spend out of pocket, Album says.
If you opt for an out-of-network dentist, you will still receive coverage, but at a reduced level.
Once your dentist has determined your treatment, always request a pre-treatment estimate from your plan. That will help you determine how much you’ll owe, Album says.
TIMING IS EVERYTHING
Schedule your procedures to make the most of your dental coverage.
Let’s say your dentist recommends four fillings and two crowns. If you do them all at once, you’ll likely exceed your maximum benefits and spend hundreds of dollars (or more) out of pocket.
If it’s not an emergency, find out when your annual benefits renew, Glasband says. For most people it’s Jan. 1.
In that case, Glasband suggests getting two fillings and a crown in November and the remaining procedures early the following year, which essentially doubles the amount of coverage at your disposal.
“Count on your dentist to help you time your benefits,” Album says.
DISCOUNT PLANS
If you don’t have dental insurance, consider purchasing a discount dental plan. These plans, which are not insurance, give you access to certain dentists who have agreed to perform procedures at discounted, cash prices.
The discounts are usually 20 to 30 percent, sometimes more, says Evelyn Ireland, executive director of the NADP.

Don't accept drug prices lying down....

9/22/2015

If you haven’t experienced it yourself, you’ve no doubt heard about the outrageous — and rapidly growing — prices of certain prescription medications.

The average price of about one year of cancer-drug therapy has skyrocketed from $10,000 (or less) before 2000 to more than $100,000 by 2012, according to a recent Mayo Clinic study.

The new hepatitis C drug Sovaldi comes at a retail price tag of $84,000 for a 12-week course.

Prices are even spiking for some generics that have been around for years. Take the cost of the commonly used antibiotic, doxycycline, which jumped from $20 for 500 pills in Oct. 2013 to $1,849 in April 2014, according to AARP.

The unaffordability of drugs is a real and growing threat, even for people with health insurance.

Today I’m going to offer some tips on how to save money on your prescription drugs, whether you’re insured or not.

Q: I was recently diagnosed with cancer and had my first round of chemo. The nurse gave me a prescription for a generic anti-nausea medication. When my wife took it to the drug store, she was quoted a price of $900 for a 30-day supply. How is that possible?

A: I wish I could answer the question from Jim Buchanan of Hemet, but I don’t know why a generic anti-nausea drug would cost $900 out of pocket, even with his insurance applied to the prescription.

I can say that his wife, Susan Buchanan, did the right thing when she didn’t take $900 for an answer. Though “totally in shock” from the quoted price, she asked what the cost of the prescription would be without applying insurance.

$45.

Counterintuitive? Yes. Confusing? Definitely.

“In some cases, people may be better off not using their insurance,” says Betsy Imholz, special projects director at Consumers Union.

Lesson 1: Shop smart.

When you get your prescription, call multiple pharmacies and negotiate, even for generics. Neighborhood pharmacies may have more autonomy to lower prices than chain stores, Imholz says.

If you don’t have insurance, however, Costco has the lowest price of chain stores on average, she says. You don’t have to be a member to use its pharmacy.

Finally, ask your doctor to write a prescription for a 90-day supply of drugs instead of 30 days. “You’ll be avoiding copays and trips to the pharmacy,” she says.

Lesson 2: Appeal for coverage.

Let’s say your doctor wants you to take a medication that’s not on your plan’s formulary and you’re faced with paying full cost.

Before you empty your pockets, file an appeal with your insurer, which in most cases must cover medically necessary drugs that aren’t on their formularies— if your condition warrants their use.

If your health plan rejects your appeal, contact your regulator and request an independent medical review, which is free. The health plan’s denial letter will specify your regulator, or try the state Department of Managed Health Care (888-466-2219 or www.HealthHelp.ca.gov) or the state Department of Insurance (800-927-4357 or www.Insurance.ca.gov).

You’ll need to work with your doctor through this process to help you prove medical necessity.

Lesson 3: Look for financial assistance.

There are a slew of programs offered by drug companies and foundations, and many websites that help you search for them. One is NeedyMeds (www.NeedyMeds.org), a national nonprofit that helps connect people with assistance.

“Pharmaceutical companies give away billions of dollars in drugs every year to people in need,” says NeedyMeds President Richard Sagall.

Financial help from pharmaceutical companies is generally for brand-name drugs that don’t have generic equivalents. These programs have eligibility requirements based on four categories, Sagall says:

Citizenship and immigration status.
Some will only help people who are uninsured or have no drug coverage.
Income. Many have relatively generous thresholds that include middle-class families.
Some are disease- or diagnosis-specific.

All require some input from the doctor who prescribed the medication, Sagall says.

If you have drug coverage but can’t afford your copay, there are programs that may help with that, too.

Other helpful websites for financial assistance include the Partnership for Prescription Assistance (www.pparx.org); Patient Services, Inc. (www.PatientServicesInc.org); and the Patient Advocate Foundation’s National Financial Resource Directory (www.PatientAdvocate.org).

You can also reach out to disease-based organizations like the Leukemia & Lymphoma Society or the American Diabetes Association.

Lesson 4: Use prescription discount cards and programs.

There are two types of drug discount cards. The first comes from pharmaceutical companies and generally offers discounts for a specific drug, Sagall says.

The other discounts multiple drugs and is offered by AARP, Costco, NeedyMeds and others. However, “you cannot use these in conjunction with insurance or state-federal programs such as Medicare,” he says.

But don’t forget the Buchanans of Hemet, who got a better deal without their insurance.

Lesson 5: Choose insurance with drug coverage you need.

One of the best ways to limit your out-of-pocket costs is to choose the best plan for your situation. You’ll have a chance to do that in your next open-enrollment period, which is fast approaching for most people.

If you have a chronic condition or take a lot of medications, try to avoid high-deductible plans, which include the “bronze” level plans sold by Covered California.

“If you have to pay a little higher premium but have lower out-of-pocket costs, that’s a better choice,” says Liz Helms, president/CEO of the California Chronic Care Coalition.

High Deductible Plans

9/21/2015

Whether you get your health insurance from your employer, Covered California or the open market, more of you are picking — or being forced into — high-deductible plans.

Although these plans come with relatively cheap premiums, you must spend thousands of dollars out of pocket before your coverage kicks in.

The price tag for the same medical procedure can vary from provider to provider, sometimes by thousands of dollars. If you want to be a savvy consumer who shops around, it is very difficult, if not impossible, for people to know with any precision what prices will be in advance.

Q: I have lower back pain and my doctor ordered an MRI. My health insurance has a $6,500 deductible. Should I go to the imaging center my doctor recommended or search for a better price elsewhere?

A: A survey by Castlight Health last year found that the price of a lower back MRI ranges from $589 to $3,076 in San Diego, depending on the provider. In Fresno, it costs between $636 and $921.

The potential for savings is great. But whether you should shop around depends on several factors.

Some health plans lend themselves to price-shopping more than others. You may have more flexibility if you have a PPO (Preferred Provider Organization) instead of an HMO (Health Maintenance Organization). I’ll explain below.

Second, price-shopping isn’t for medical emergencies. It’s most appropriate if you need what Jeanne Pinder calls a “discretionary procedure” that allows you choice in providers and time to research.

Pinder is a former New York Times journalist who started ClearHealthCosts.com in 2011 when she realized that people were being told to be active healthcare consumers without having the tools – or reliable price data – to do so.

She warns consumers not to assume that high prices equate to better quality. “Study after study has shown that price and quality are not linked,” she says.

In California, ClearHealthCosts has partnered with NPR radio stations in Los Angeles and San Francisco to create PriceCheck sites where consumers can report – and search – costs for several common procedures, including mammograms and colonoscopies.

Before you start shopping, ask your doctor for the exact name of your treatment and the accompanying procedure codes. There may be more than one, and you’ll need them all for an accurate estimate.

Once you have that information, dive in:

First, read the Healthcare Financial Management Association’s consumer guide, “Understanding Healthcare Prices,” available at www.hfma.org/consumerguide. It will help you understand key terms and concepts that are critical to making informed decisions.
If you have job-based insurance, your employer may provide resources, such as Castlight Health’s price and quality data. Check with your human resources department.
Consider the provider’s network status, which may affect how much insurance coverage you receive and whether the amount you pay out of pocket will be applied to your deductible. With an HMO, for instance, “if you go out of network without the insurer’s approval, the procedure won’t be covered at all,” says Charles Bacchi, president of the California Association of Health Plans.
Call your health plan or check its website. Many have cost calculators that will help you compare prices at different facilities. “In some cases, health plans will be specific about the price of a service and other times, they can’t be,” Bacchi says. “That’s because of their contractual obligations to providers who don’t want price or quality data to be reported publicly.”
Sample several online resources to understand price range. In addition to ClearHealthCosts, FAIR Health has a “Consumer Cost Lookup” tool at FairHealthConsumer.org. This fall, Consumers Union, working with UC San Francisco and the state, will launch another site highlighting the costs of some common procedures by region, Imholz says.
If you can’t pinpoint the exact price, look for the amount that Medicare reimburses for procedures in your region, which is “the closest thing to a fixed benchmark price in the marketplace,” Pinder says. Find them at ClearHealthCosts by procedure code or by searching the Medicare Physician Fee Schedule lookup tool at www.cms.gov.
Call providers directly and ask about cash rates. They may give you a lower price if you pay up front and/or agree not to bill your insurance. “Don’t be afraid to ask for a lower price,” Pinder says. To be clear, if you pay cash, your outlay may not be applied to your deductible.

In all of these cases, when you’re quoted a price, make sure you understand what the figure means. Is it the full cash price? Is it the portion you would pay if your insurance were applied? Is it an average?

And remember, this isn’t foolproof. You may come across conflicting information in your search or contend with providers who won’t tell you the exact cost of a procedure.

3 Reasons to Say NO to E-Cigarettes

6/24/2015

Electronic cigarettes (e-cigarettes) are marketed as a safer alternative to traditional cigarettes and a way to manage nicotine cravings if you’re trying to quit. But here are 3 good reasons to give them a thumbs down.

1. Safety concerns
After analyzing e-cigarette samples, the U.S. Food and Drug Administration (FDA) found that some products contain cancer-causing agents and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.

2. No convincing evidence they will help you quit
In fact, there is evidence suggesting the opposite: A 2014 study by researchers at the University of California, San Francisco, revealed that smokers who use e-cigarettes are a third less likely to quit than those who don’t use them.

3. What’s proven to work still works
Evidence shows the most effective way to quit is to use a combination of FDA-approved medications (like the nicotine patch, gum, lozenge, or bupropion) and counseling support. Choose what works for you: Kaiser Permanente’s Wellness Coaching by Phone, tap into the power of a group in a Health Education stop smoking class, or try the online, self-paced program called HealthMedia® Breathe.(TM)

Information if you end up at the ER

4/1/2015

I wanted to touch base with you and see how everything is going with your health insurance plan? Open enrollment for 2015 was tougher for everyone than the initial signup. One thing I want you to know about is if you have to go to the hospital or ER and they demand payment right there, per the carriers, don't do it. They have to go through the normal process of submitting the claim to the carrier. I recently had someone call me and said that the people at the ER were demanding cash or credit card right there on the spot and he didn't know what to do. He didn't pay them and insisted they use his insurance card which they eventually did. The carrier said this is becoming a problem and they need to submit the claim to them first. I bet a lot of people buckle and pay over the intimidation.

Can an Insurance Company Force You to Replace Your Roof?

8/13/2014

In some cases, your home’s state of disrepair can become a costly problem for an insurer. When you have loose shingles on your roof, doors that are cracked or easily compromised, and debris lying around your yard, you increase the risk of suffering damages during an insurable incident which increases the likelihood that your insurer will need to pay out a claim at some point. With that said, while it would be in the insurance company’s best interest for you to improve these areas and reduce their risk of claims exposure, they can’t actually make you take action.

The Insurer is Not The Boss of You

Insurance companies are simply companies that agree to pay for the losses you suffer at the hands of insurable incidents. They do not dictate how you can and should keep your home. The insurance company does not get to mandate whether or not your roof is replaced when it reaches a certain state of disrepair, nor do they get to decide when and how you should make repairs to any part of your home. It is ultimately, the responsibility of each individual home owner to decide what, when, and how to make improvements to their home.

What an Insurance Company CAN Do

That doesn’t mean insurance companies are completely powerless in compelling you to make changes. If an insurer gets the sense that your lack of repairs is increasing their exposure to risk, they can either raise your rates or decide to not renew your premium.

Insurance companies have a big responsibility to accurately assess risk and take measures to protect themselves against it. They must do this in order to ensure that they will have the funds to pay for all the claims they receive from their other policyholders. If the way you choose to maintain your home increases the risk that you present, then the insurance company has no choice but to raise your rates to reflect that increased risk or to lose you as a customer. If they don’t take these steps, they expose other customers to the possibility that they can’t pay for their claims.

It is always in a homeowner’s best interest to maintain their home to the best of their abilities. In fact, much of the damage that occurs as a result of poor maintenance is less than a home insurance deductible and doesn’t occur as an insurable incident, anyway—which means the homeowner has no one to blame, and no one to pay, but themselves.