header image

[Sign Up Now] to Receive Our FREE Daily SCVTV-SCVNews Digest by E-Mail

Inside
Weather


 
Calendar
Today in
S.C.V. History
March 28
1934 - Bouquet Canyon Reservoir, replacement for ill-fated St. Francis Dam & reservoir, begins to fill with water [story]
Bouquet Reservoir


Commentary by David Sayen
| Monday, Nov 18, 2013

davidsayen_2012Some people might not realize it, but there are actually two ways to get Medicare benefits.

The best-known way is Original Medicare. With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly.

The other way is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage companies may offer some coverage – such as dental, hearing, vision, and wellness programs – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you sometimes pay an additional monthly premium to the private insurance company that covers you.

With Original Medicare, you must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy a type of supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Medigap policies also are sold through private companies. All plans offer the same basic benefits but some offer additional benefits. The costs vary between insurance companies – and often cost is the only difference between policies. Some Medigap policies also offer benefits that Original Medicare doesn’t, such as medical care when you travel outside the United States.

Original Medicare generally doesn’t cover prescription drugs. If you want drug coverage, you can get it through Medicare Part D. Part D policies are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

About 75 percent of Medicare beneficiaries choose Original Medicare, with the rest getting coverage through Medicare Advantage.

Medicare Advantage companies must cover all of the services that Original Medicare covers, except hospice care and some care in qualifying clinical research studies. (Original Medicare covers hospice and qualifying clinical research care even if you’re in a Medicare Advantage plan.)

In all types of Medicare Advantage plans, you’re covered for emergency and urgent care. Most Medicare Advantage plans also include prescription drug coverage.

But the plans can charge different out-of-pocket amounts and they have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in their provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a more detailed explanation of the differences between Original Medicare and Medicare Advantage in the “Medicare & You” handbook. An updated version of “Medicare & You” is mailed to all Medicare beneficiaries every fall.

You can also find “Medicare & You” on our website, www.Medicare.gov. If you have any questions, you can always call Medicare’s toll-free number, 1-800-MEDICARE (1-800-633-4227).

 

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories.

Comment On This Story
COMMENT POLICY: We welcome comments from individuals and businesses. All comments are moderated. Comments are subject to rejection if they are vulgar, combative, or in poor taste.
REAL NAMES ONLY: All posters must use their real individual or business name. This applies equally to Twitter account holders who use a nickname.

0 Comments

You can be the first one to leave a comment.

Leave a Comment


Opinion Section Policy
All opinions and ideas are welcome. Factually inaccurate, libelous, defamatory, profane or hateful statements are not. Your words must be your own. All commentary is subject to editing for legibility. There is no length limit, but the shorter, the better the odds of people reading it. "Local" SCV-related topics are preferred. Send commentary to: LETTERS (at) SCVNEWS.COM. Author's full name, community name, phone number and e-mail address are required. Phone numbers and e-mail addresses are not published except at author's request. Acknowledgment of submission does not guarantee publication.
Read More From...
RECENT COMMENTARY
Wednesday, Mar 27, 2024
Remo, Inc. is is the world's leading manufacturer and developer of synthetic drumheads and shells. They’ve been in business for 60 years
Tuesday, Mar 26, 2024
Springtime in Santa Clarita brings not only vibrant blooms and opportunities to embrace the outdoors with warmer weather, but also an array of free, family-friendly events and this Saturday is no exception.
Thursday, Mar 21, 2024
Did you know that each year, Main Street in Old Town Newhall undergoes countless makeovers for different events, such as Light Up Main Street and the Fourth of July Parade?
Thursday, Mar 21, 2024
Los Angeles County Supervisor Kathryn Barger, whose Fifth District includes the Santa Clarita Valley, issued the following statement Thursday in response to an announcement by Federal Communications Commission Chairwoman Jessica Rosenworcel of a proposal to change how calls to the 9-8-8 Suicide and Crisis Lifeline are routed.
Monday, Mar 18, 2024
Unlike our children who enjoy a week-long spring break, we adults no longer have that luxury.
Friday, Mar 15, 2024

Latest Additions to SCVNews.com
Los Angeles County Public Works is updating the Los Angeles County Bicycle Master Plan.
April 16:  County Bicycle Master Plan Virtual Community Meeting
College of the Canyons mens golf got back on track during its return to conference play on Monday, carding a five-man score of 370 to top the eight-team field at Brookside Golf Course and maintain its unblemished conference mark.
Cougars Win Again, Keep Conference Streak
Los Angeles County Treasurer and Tax Collector, reminds property owners that the second installment of the 2023-24 Annual Secured Property Taxes becomes  delinquent if not received by 5 p.m. Pacific Time or United States Postal Service postmarked on or before Wednesday, April 10, 2024.
County Treasurer Reminds Property Owners of April 10 Due Date
Local nonprofit Fostering Youth Independence is seeking “Allies” to support Santa Clarita youth who are aging out of the L.A. County foster care system.
April 16: FYI Seeks Volunteers To Pair With Local Foster Youth
The Los Angeles County Department of Public Health today unveiled the latest L.A. County Health Survey, which gathers vital data on health behaviors, conditions, neighborhood settings, and the needs of L.A .County residents, informing future public health policies and programs.
Public Health Unveils the 2023 L.A. County Health Survey Findings
Due to the projected rain forecast, Eggstravaganza will now be held indoors at the Canyon Country Community Center beginning promptly at 10 a.m. on March 30.
March 30: Eggstravaganza Now Being Held Indoors at Canyon Country Community Center
To support the mental health of California's young people, the California Department of Public Health awarded $25 million to 28 tribal and community-based organizations across the state.
California Announces $25 Million in Awards for Youth Mental Health
The College of the Canyons Athletic Department will host a dedication ceremony to unveil the Michele Jenkins Softball Team Room in honor of the longtime board member and ardent softball program supporter’s nearly 40 years of service to the district.
April 16: COC to Host Michele Jenkins Team Room Dedication Ceremony
PFLAG Santa Clarita has announced the establishment of the Peggy and Jeff Stabile PFLAG SCV Scholarship. The scholarship will provide financial assistance to LGBTQIA+ students pursuing higher education and committed to advocating for LGBTQIA+ rights and promoting diversity and inclusion.
PFLAG SCV Announces Stabile PFLAG Scholarship
1934 - Bouquet Canyon Reservoir, replacement for ill-fated St. Francis Dam & reservoir, begins to fill with water [story]
Bouquet Reservoir
The California Department of Public Health launched the “Never a Bother” campaign, a youth suicide prevention public awareness and outreach campaign for youth, young adults, and their parents, caregivers, and allies.
California Launches New Youth Suicide Prevention Campaign
The Santa Clarita Master Chorale invites the community to "Let the Sunshine In," a delightful evening of food, wine and song at the annual Cabaret & Cabernet fundraising benefit.
April 20: Santa Clarita Master Chorale’s Cabaret, Cabernet Fundraiser
The Los Angeles County Department of Public Health cautions residents who are planning to visit the below Los Angeles County beaches to avoid swimming, surfing, and playing in ocean waters:
March 27 Ocean Water Warning
As an integral ingredient necessary to help the Santa Clarita Valley to flourish, feedback from the business community is the secret sauce for achieving great things.
SCVEDC Asks For the Business Community’s Opinion on Santa Clarita
Raise your heart rate while raising funds for the Santa Clarita Sister Cities Dollars-for-Desks campaign to provide school desks for students in Sariaya, Santa Clarita's Sister City in the Philippines.
April 13: Sister Cities Zumba-thon Fundraiser
Remo, Inc. is is the world's leading manufacturer and developer of synthetic drumheads and shells. They’ve been in business for 60 years
SCVEDC Company Spotlight: Drumming Up Big Business with Remo, Inc.
California State Assemblywoman Pilar Schiavo (D-Chatsworth) and Assemblyman James Ramos (D-Highland) have introduced AB 3074 the "School or athletic team names: California Racial Mascots Act."
Schiavo Introduces Bill to Prohibit ‘Derogatory’ School Mascot Names
Los Angeles County’s Justice, Care and Opportunities Department  in collaboration with Local Initiatives Support Corporation Los Angeles is proud to announce the 2nd Annual Pitch Competition for the cohorts of JCOD's Incubation Academy.
March 28: JCOD Incubation Academy Helps Grassroots Non-Profits For the Second Year
Children’s Bureau is seeking foster families and now offers two virtual ways for individuals and/or couples to learn how to help children in foster care while reunifying with birth families or how to provide legal permanency by adoption.
April 18: Children’s Bureau Hosts Virtual Orientation
The Sunburst track was constructed in 1887 by the Southern Pacific Railroad and was a part of the main line running between San Francisco and Los Angeles.
Enjoy Spring With a Ride On The Sunburst Track
California State Superintendent of Public Instruction Tony Thurmond hosted a Personal Finance Summit today where he announced his support for Assembly Bill 2927 (McCarty), legislation that would require a personal finance education course for California high school graduation.
State Superintendent Announces Support for Personal Finance Graduation Requirement
1847 - Probable birth date of Pico Canyon oil driller Charles Alexander Mentry [story]
C.A. Mentry
The first Music Jam Session at The MAIN was held on Thursday, Feb. 22 and was a hit. Come out and join in for the next one on Thursday, March 28 7 p.m.-9 p.m.
March 28: The MAIN to Host Musicians’ Jam Session
SCVNews.com