Coverage Choices

You can decide if you’d like to receive your medical coverage through Medicare and a Supplement (that will pay some or all of your out of pocket medical costs) OR via a Medicare Advantage plan.  In Santa Cruz County, Medicare Advantage plans are all currently in the form of HMOs.

HMO plans require that you select a Primary Care Physician (PCP) who will direct all of your medical care.   You’ll  need a referral to see a specialist, and all of your doctors will be from the same medical group.  Before selecting an HMO plan, we’ll want to help you look up your doctors in the networks available to be certain they’re in your network.

Here’s a chart to clarify your options:

 

Pros & Cons of Medicare Supplement vs Medicare Advantage

 

Medicare Supplement

Medicare Advantage HMO

Use Any provider willing to bill Medicare

Use only providers in your plan

Good throughout the U.S.A.

Network Only coverage unless a medical emergency occurs outside of your local area

No out of pocket Medical expenses on an “F” Supplement for all Medicare Covered Services

Copayments vary and can be high for hospital stays.  Out of Pocket Maximum as much as $6,700

May select any Part D plan, but it will be a second plan with a second bill (or Social Security Check deduction)

Part D benefits included, simplicity of one plan

Rates vary by age and increase annually

Rates may increase annually due to inflation, but no age rating.  Generally less expensive than Medicare Supplement plans

Premiums may be paid by check, automatic bank draft, sometimes credit card

Premiums may be paid by check, bank draft, Social Security Check deduction, sometimes credit card

Guaranteed Issue (no medical questions) when first eligible for Medicare and if coverage is lost through group plan or Medicare Advantage

Guaranteed Issue (no medical questions) when first eligible for Medicare and annually during the Election Period from October 15 – December 7Exception — End Stage Renal Disease

Can switch carriers to same or lower benefit during your birthday month

Can switch plans and carriers every year during the fall