Published in the June 13 – 26, 2018 issue of Gilroy Life
Medicare Parts A, B, C, D, Medicare Supplements … confused? You’re not alone. So are most Gilroy residents. The Golden Years are upon you, you’re getting on Medicare and trying to figure out what you need to do. Your friends and family are giving you a lot of information and unfortunately often they are misleading you.
All of this leads to an unsettling feeling. It doesn’t feel so golden, does it? I have clients tell me all the time, how confused they are and that they’ve tried to read through all the information. That just seems to make them more confused. I’ll try to explain it as best I can here, but the best thing to do, is reach out to an agent or someone who knows all the rules and can explain it to you in a very simple way. There is no cost to use an agent, we are an advocate and a resource for you.
Medicare Part A & B are Original Medicare only. All of the other parts are always offered by an insurance company. Part A is the hospital part of the insurance, which also includes skilled nursing stays, hospice care and a few other benefits. There are limited days of coverage, it’s not open-ended, so you will need to look into the details of the coverage.
Medicare Part B is the Medical part of the coverage, which covers services such as doctor visits, emergency room visits, diagnostic tests, outpatient surgery, lab services, physical and other therapies, home healthcare and many other benefits. This is the most used portion of the coverage. To see the full coverage for both parts A and B, you can go to Medicare.gov or look in the Medicare & You handbook which is also available on Medicare.gov in pdf format.
Part C is also called a Medicare Advantage plan, which can be an HMO or PPO plan, however, in Santa Clara County, there are only HMO’s. With these Medicare Advantage plans, you have to use a specific network of doctors, labs, etc. You must pick a Primary Care Physician and manage your care through this doctor. You need to get referrals to see specialists. If you go out of network, except for urgent care and emergencies, you will not be covered unless you are referred. The key to being satisfied on these plans is being sure your doctors are in network and knowing how the plan works before you enroll into it. There’s nothing worse than finding out you have a large bill after you’ve incurred it.
Part D is the Prescription Drug Plan, which Medicare requires you to have, but again, they do not offer any Part D plans, only insurance companies do. There are more than 20 plans available and there is a method to picking a plan. First you want to make sure your drugs are covered by looking at the plan’s formulary (list of covered drugs). There are formulary exceptions if your drug isn’t covered by the plan, where your doctor can help you get the drug covered, so it’s best to go with a plan that has your drug covered to begin with. The other key question to look into is, does your pharmacy work well with the plan? It could cost you a lot more money if they don’t work well together, meaning they are not a preferred pharmacy or don’t work with that pharmacy at all.
Medicare Supplements are another piece of the puzzle that fit in with Medicare. None of the above are called a Medicare Supplement, but people think their Medicare Advantage plan is a supplement plan. There are many options of supplements to choose from and all have different costs. Even if Medicare is not new to you or if it is, you can always reach out to an Insurance Agent that focuses in the Medicare health plan market to do a full review of your needs.
Michele Campbell is the owner of Michele Campbell Insurance in Gilroy. She can be reached at (408) 848-2271.
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