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

Inside
Weather
Santa Clarita CA
Sunny
Sunny
51°F
 
Calendar
Today in
S.C.V. History
January 18
1899 - Martin & Richard Wood buy J.H. Tolfree's Saugus Eating House, rename it Saugus Cafe [story]


Commentary by David Sayen
| Thursday, Nov 6, 2014

davidsayen091114You might not realize it, but there are actually two ways to receive your 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 within the company’s network.

On the other hand, Medicare Advantage plans may cover some benefits – such as dental, hearing, and vision – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. Some Medicare Advantage plans charge an additional monthly premium; others don’t.

With Original Medicare, you must pay deductibles and/or coinsurance when you get care.

To cover these “gaps” in Medicare, some people buy 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.

Original Medicare generally doesn’t cover prescription drugs. If you want drug coverage, you can purchase it through Medicare Part D. Like Medicare Advantage, Part D plans are sold by private companies, which charge a monthly premium for them.

About 70 percent of Medicare beneficiaries are currently in Original Medicare; the rest get 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 some 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 can 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. This handbook is mailed to all Medicare households every fall. It’s also available 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). Customer service representatives are available 24/7.

If you’d like to join a Medicare Advantage or Part D drug plan, you can do so during Medicare’s Open Enrollment Period, which ends Dec. 7, 2014.

If you’re in Original Medicare and you’re satisfied with it, you don’t need to do anything during Open Enrollment.

 

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.

1 Comment

  1. Well written article. As a case manager/medical social worker, I can tell you what all case managers preach to their own families: NEVER sign away your Original Medicare coverage. HMO Managed Plans do not always cover extended care and, whrn they do, they never cover as long a period as Medicare. You will get the best coverage from Medicare, especially when it comes to hospitalization and short term rehab services (orthopeadic, etc.)

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
Thursday, Jan 11, 2018
There may come a time in your life when you need mental health care. Your Medicare covers a wide variety of such services, in both hospital inpatient and outpatient settings.
Monday, Jan 1, 2018
Santa Clarita City Manager Ken Striplin previews Year 4 of the city's five-year Strategic Plan in his monthly message for January 2018.
Sunday, Dec 10, 2017
Derelict since the 1994 earthquake, the Pioneer Oil Refinery in Newhall was the first productive oil refinery in the American West and is believed to be the oldest existing refinery in the world today. Unfunded restoration plans have come and gone. Now that the surrounding property is under development, will the promises be kept?
Friday, Dec 8, 2017
A National Memorial designation for St. Francis Dam will honor those who lost their lives in the nation’s worst engineering disaster and the role it played in ushering in a new era of oversight for dam construction.
Thursday, Dec 7, 2017
Eliminating net neutrality would allow Internet service providers such as Verizon, Comcast, Spectrum and AT&T to create a “slow lane” and a “fast lane” on the Internet, prioritizing certain companies over others and dictating what websites you’re able to visit and at what speed, or even blocking you entirely from visiting certain websites of your choice.
Monday, Dec 4, 2017
In his monthly message for December 2017, Santa Clarita City Manager Ken Striplin encourages residents to shop and party locally during the holidays to keep the cash in our community.

Latest Additions to SCVNews.com
1899 - Martin & Richard Wood buy J.H. Tolfree's Saugus Eating House, rename it Saugus Cafe [story]
The dismantling of a multi-state drug trafficking organization that used the U.S. Postal Service to mail packages of crystal methamphetamine and marijuana from California to traffickers in Pennsylvania since at least April 2016 - and the arrests of five leaders who spearheaded the corrupt organization, including two from the Santa Clarita Valley - were announced Wednesday by Montgomery County (Penn.) District Attorney Kevin R. Steele.
2 from SCV Netted in Major East Coast Drug Bust
With The Master's University's 2018 baseball season about to begin, TMU Sports Information Director Mason Nesbitt offers a preview.
TMU Previews Mustangs’ 2018 Baseball Season
Several CalArtians are among the Chicago-based United States Artists' annual fellowship class of 45 artists and collaboratives who will each receive an unrestricted $50,000 grant for their respective art practices.
CalArtians Among United States Artists’ New Fellowship Class
The TMU Mustangs' men's basketball team, on a 17-game winning streak, has moved up to No. 4 in the NAIA Division 1 Men's Basketball Coaches' Poll.
TMU Men’s Hoops Team Up to No. 4 in NAIA Coaches’ Poll
Tuesday night's 93-37 rout of St. Katherine University was more than just a non-conference tune-up for the TMU women's basketball team.
Master’s Women’s Hoops Team Shoots Down Firebirds
iLEAD Schools will honor College of the Canyons Chancellor Dr. Dianne Van Hook with its 'Vision in Education' award at the Santa Clarita Valley International School’s annual benefit dinner on March 10.
iLEAD to Honor COC’s Van Hook with 2018 ‘Vision in Education’ Award
Los Angeles County Fire Department firefighters quickly extinguished a 1/4-acre brush fire in Newhall early Wednesday afternoon.
Small Brush Fire in Newhall Quickly Doused
Los Angeles County Assessor Jeffrey Prang and the county Board of Supervisors have proclaimed January "Homeowners' Exemption Awareness Month" promote the county's property tax savings program.
County Officials:  January is ‘Homeowners’ Tax Exemption Awareness Month’
In an effort to provide support to local communities affected by the recent hurricanes in the Caribbean, and after the sell-out of the inaugural group on the January 20 Crown Princess sailing, Princess Cruises and Fathom Travel are adding two additional spring sailings in 2018.
Princess Adds More Caribbean Cruises for Spring 2018
California State University, Northridge journalism professor David Blumenkrantz documents the stories of the homeless of Los Angeles in an art exhibition titled “Street Scenes: Making the Homeless Count,” on display at the San Fernando Valley Arts and Cultural Center in Tarzana through Jan. 27.
CSUN Prof Uses Grant to Illuminate Homelessness in LA
Host College of the Canyons rallied from a nine-point halftime deficit to defeat the visiting Seahawks of Los Angeles Harbor College 96-82 on Saturday evening.
Cougars Win Third Straight with 96-82 Victory Over L.A. Harbor
The Los Angeles County Sheriff’s Department is stepping up bike and pedestrian safety enforcement operations in the Santa Clarita Valley today, officials announced this morning.
Deputies Step Up Pedestrian, Bike Safety Enforcement Today
Santa Clarita Valley Sheriff's Station deputies checking on businesses after hours arrested two people on drug charges in separate incidents in Canyon Country on Monday and Newhall on Tuesday.
Deputies Check Businesses After Hours, Arrest 2 on Drug Charges
A Canyon Country man was killed and three people injured in a high-speed traffic collision on Golden Valley Road at Dorothy Street in the unincorporated area of the Santa Clarita Valley late Tuesday night, according to the CHP.
High-Speed Crash in SCV Leaves 1 Dead, 3 Injured
The U.S. Justice Department is appealing a court order that blocked the Trump administration from shutting down a program that shields more than 700,000 young immigrants from deportation.
Justice Dept. to Appeal Ruling That Blocked DACA Shutdown
A Los Angeles County sheriff’s officer was arrested Tuesday and charged with taking bribes 'to oversee the delivery of narcotics,' federal prosecutors said.
Dirty LA Sheriff’s Officer Busted for Drugs, FBI Says
The cost of the first phase of California’s high-speed rail project through the state’s Central Valley has soared by 35 percent to $10.6 billion, officials disclosed Tuesday.
California Bullet Train Cost Climbs by $2.8 Billion
Dozens of attorneys general including California's filed a petition Tuesday challenging the Federal Communication Commission’s recent decision to roll back net neutrality rules.
State AG’s Sue FCC to Block Net Neutrality Rollback
1994, 4:31 a.m. - Magnitude 6.7 Northridge earthquake rocks Santa Clarita Valley [video]
More than 4,000 newborns in Los Angeles, including some in the SCV, will be sporting little red caps, instead of the traditional pink or blue, as part of the American Heart Association’s Little Hats, Big Hearts program aimed at bringing attention to heart disease.
Newborns to Sport Little Red Caps as Part of AHA Campaign
College of the Canyons Small Business Development Center (SBDC) will be hosting a two-part Business Events and Training Webinar Jan. 24 (Part 1) and Jan. 31 (Part 2) from 12:00 p.m. - 1:00 p.m.
Jan. 24, 31: Start, Grow Your E-Commerce Empire Webinar
The Santa Clarita Valley Veteran Center has found a permanent home in Newhall.
SCV Veteran Center Finds Permanent Home
The California Enterprise Development Authority will be holding a Teleconference Meeting Thursday at 10:30 a.m.
Jan. 18: CEDA Teleconference Meeting
The Oversight Board to the Former Redevelopment Agency of the city of Santa Clarita will hold its Regular Meeting Thursday at 3:30 p.m.
Jan. 18: Oversight Board to the Former Redevelopment Agency Regular Meeting
NORTHRIDGE, Calif - The 2018 CSUN Water Polo season presents the opportunity for the Matadors to take the next step.
Matadors Start 2018 Water Polo Season Ranked No. 21
Santa Clarita Valley International (SCVi), a free public charter school serving grades TK through 12, will host an informational session Thursday for current and prospective high school students in the school’s Shakespeare Theatre at 28060 Hasley Canyon Road in Castaic, the school announced Tuesday.
Jan. 18: SCVi Open House, High School Information Session
Commercials, television shows, and a short film are all being filmed in Santa Clarita this week.
Currently Filming in SCV: Shadow Wolves, Seal Team, Toyota Commercial
SACRAMENTO – Attorney General Xavier Becerra joined a bipartisan group of 18 state attorneys general Tuesday in urging Congress to advance legislation that will enable the cannabis industry to participate in the banking system in states that have legalized medicinal or adult use of cannabis.
Becerra, State AGs Press Congress to Let Cannabis Biz Use Banks
The 25th Anniversary of the City of Santa Clarita’s annual Cowboy Festival, presented by Heritage Sierra Medical Group, is set for Apr. 19 - Apr. 22.
Dates Set for Cowboy Festival’s 25th Anniversary
College of the Canyons, in partnership with the Santa Clarita Valley Senior Center, will host a free “Family Caregivers Essentials” workshop on Saturday, Jan. 27 at the Santa Clarita Valley Senior Center.
Jan. 27: Family Caregiver Workshop at SCV Senior Center
SACRAMENTO, Calif. - As the California High-Speed Rail Authority continues to move from the planning phase to full construction of the nation’s first high-speed rail system, the Board of Directors announced Tuesday that it has selected a new Chief Executive Officer, Brian P. Kelly, to lead the organization, effective Feb. 1.
Brian P. Kelly Named New High-Speed Rail Authority CEO
During her first 25 years in the Santa Clarita Valley, Betty served on the board of the Child and Family Center. She was also a volunteer for the American Red Cross, the American Heart Association, the SCV Chamber of Commerce, the Zonta Club of SCV, the SCV Boys and Girls Club, and the local Elks Lodge.
Seldner, 2000 SCV Woman of the Year, Dies at 94
1926 - Newhall Community Hospital, est. 1922, opens in larger, more modern hospital building at 6th & Spruce streets [story]
The cities of Santa Clarita, Piru, Fillmore, Bardsdale and Santa Paula along with National Historic Site Rancho Camulos will mark the 90th anniversary of the St. Francis Dam Disaster with special events throughout March 2018.
St. Francis Dam Disaster 90th Anniversary Events Set for March
A man arrested for allegedly burglarizing a Walmart Monday morning posted bail, then was soon arrested again for allegedly vandalizing the Valencia Library, according to officials.
Man Arrested After Alleged Walmart Burglary, Library Vandalism