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Health Matters: Providence Saint John's Health Center | 11 Is there more than one Medicare plan? Yes, there are Medicare and Medicare Advantage plans. Original Medicare is the government-based plan and covers a majority of medical expenses but not everything. You could be responsible for 20% of the allowed charges. It also doesn't cover prescriptions. Some people get a supplemental plan through an insurance company to cover these costs; however, it results in monthly payments that vary according to the plan you choose. Medicare is similar to a PPO, giving you the ability to choose your own doctors and hospitals. Medicare Advantage covers most costs, including prescriptions, but operates more like an HMO. There are several different insurance companies that offer Medicare Advantage at very minimal cost to you. You are assigned a primary care physician who acts as the conductor in your health care and ensures there is a coordination of care among any specialists you might need to see. How do Medicare and Medicare Advantage differ? With a Medicare card, you have choices and can go to any doctor who accepts it. As mentioned above, Medicare covers 80% of allowed charges, and you are responsible for 20%. There's an annual deductible of $230 for doctor visits and $1,400 for hospital care. If being able to go to any doctor is important to you, then you should choose the supplemental (Medigap) route to get insurance coverage for the costs that Medicare doesn't cover and are your responsibility. If you're more concerned about lowering your costs, then you want to go the Medicare Advantage (HMO) route, which covers a network of doctors and services within the plan. There are no deductibles with HMOs, small co-pays for certain items and a maximum amount for out-of- pocket costs. Am I limited to choosing the plan I want only when I turn 65 and enroll in Medicare? No, in fact, it is always good to review your coverage every year during open enrollment, which runs Oct. 15 through Dec. 7. Insurance broker services are complimentary and they can help you choose the best plan for you based on your medical and pharmaceutical needs. With supplemental plans, drug co- pays can change. With HMOs, all co-pays can change and sometimes providers are no longer in the network. If you're on a supplemental plan, it's important to check your prescription drug plan—which is a separate plan you sign up for known as Medicare Part D—to see if the medications you use are covered. With HMO plans, drugs are included, but you need to check on which are covered and how much, and whether your preferred doctors and hospitals are still within your network. With both types of plans, any benefit changes are announced Oct. 1 and become effective Jan. 1. This includes changes in co-pays and drug coverage for both types of plans. Do you need to check if your preferred hospitals are still in your plan? If you have original Medicare, any hospital will take you. If you have an HMO, you agree to a network of specific physicians and hospitals to use for elective admissions. For emergencies, you're covered at all hospitals by both types of plans. What are the advantages of choosing a plan with physicians affiliated with Providence? Providence has an excellent network of renowned physicians, including those who specialize in cardiology, cancer, neurology and orthopedics. Our network of physicians, hospitals, urgent care centers and many other services spans Los Angeles and Orange counties and the Victor Valley region of the High Desert. Wherever you are, you will have care. Can you change plans at any time other than the open enrollment period? From Jan. 1 to March 31, people can only go from one plan to a similar one—and there's a birthday rule that applies to Medicare supplemental plans. During your birth month, you can switch from one supplemental carrier to another and do not need to go through underwriting. Can you explain what a five-star plan is? Medicare uses ratings of 1 to 5 stars to rate their plans. A 5-star rating is considered excellent. If a Medicare Advantage Plan, Medicare drug plan or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star special enrollment period to switch from your current Medicare plan to a Medicare plan with a "5-star" quality rating. You can use this special enrollment period only once between Dec. 8 and Nov. 30 the following year. How can you best decide which plan is right for you? By consulting with an independent local broker, you will get someone who knows all the plans, can assess your current health care needs and can make recommendations for the plan that's best for you. You'll receive current, appropriate and reliable information from someone you can call anytime you have questions. Some brokers conduct seminars and teach people about Medicare and how to select a plan, with most providing this information both online and in person. Anyone seeking guidance on Medicare insurance options can call our Medicare Helpline at 844-992-1260 (TY 711) or visit us online at providence.org/lp/ medicare.

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