Medicare & You - just about everything you want to know
Medicare & You – just about everything you want to know

Introduction to Medicare Advantage Plans, Medi Gap &
Medicare Prescription Drug Plan (PDP) aka  Part D Rx

Medicare & You Publication # 10050 gives an EXCELLENT Overview and most of the Information you will ever want to know. 

New to Medicare? 

Learn about how to enroll in Part A Hospital and Part B Doctor Visits and then follow the link to Medicare’s site where you can enroll.

Medicare complies with Health Care Reform, so you do NOT need to get a policy from Covered CA.  It fact, it’s illegal for anyone to sell you a policy!  Kaiser Health News  Covered CA FAQ   Health Care.Gov

Medi-Gap  (Medicare Supplements)


Pay the medical expenses that Original Medicare Part A (Hospital) and Part B (Doctor) doesn’t.  Medicare nor Medi Gap pays for long term (nursing or home- click to learn more) care.

Medicare Advantage Plans  aka Part C

These plans often include Dental &  Part D – Rx Prescriptions   and often have NO premiums!  How is that possible? The Federal Government pays them around $700/month to handle your medical care.  You must continue to pay your Medicare Part B premium of about $105/month.  It’s best to apply when you turn 65 for the supplement plans or advantage plans, as that’s the main “Open Enrollment” period, guaranteed issue for any plan.  Medicare Advantage Plans also have an annual open enrollment starting in October. 

Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or possible bankruptcy?

 Consumer Resources & Links

Medicare.Gov Eligibility Tool 

CBS News 10.2015 How will you get Health Insurance in Retirement?

History of Medicare CMS.Gov

California Medicare.org

Calif. Department on Aging

Kaiser Foundation – Medicare Chart Book

2015 Costs to remain the same CA HealthLine

Law Help.org  Medicare

medicare.gov/cost/ deductibles, co pays, premium

Reforms to the Medicare payment system are meant to promote greater efficiency in the healthcare delivery system by restructuring Medicare reimbursements from fee-for-service to bundled payments.[44][45] Under the new payment system, a single payment is paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers. In addition, it has been asserted that the Medicare Part D coverage gap (commonly called the “donut hole“) will shrink incrementally, closing completely by January 1, 2020.[46]   Wikipedia

The CBO averred that the bill would “substantially reduce the growth of Medicare’s payment rates for most services; impose an excise tax on insurance plans with relatively high premiums; and make various other changes to the federal tax code, Medicare, Medicaid, and other programs”[216]—ultimately extending the solvency of the Medicare trust fund by 8 years.[249]

Q & A on Medicare’s Website ♦  Health Affairs.org ♦  AHIP info  ♦   See our Medicare Advantage Page

Set a personal Consultation Time 

 More Pages in this section that might be of Interest

Please use the menu at the top, visit our site map. or see below

Washington Post – How to select the options

Official Medicare Guide to choosing a Medi Gap Policy # 02110
Official Medicare Guide to choosing a Medi Gap Policy # 02110

medicare.enrollmentPublication 11036 28 Pages

Get Quotes from ALL Plans & Companies - We won't be your agent, but do get a finders fee
Get Quotes from ALL Plans & Companies - We won't be your agent, but do get a finders fee

5 comments on “Medicare – Introduction

    • Generally no, it’s automatic renewal.

      I presume you are talking about a Medicare Advantage plan. Yes, there are warnings all over the “typical” Summary of Benefits that Medicare must renew the contract with the insurance company for your plan to renew.

      Did you get an ANOC – Annual Notice of Change or cancellation notice?

      What should I do if I get this notice?

      Review any changes to decide whether the plan will continue to meet your needs in the next year.
      If you don’t get this important document, contact your plan.

      If you send us privately [email protected] your current ID card or other documentation to verify your current coverage, we can see what your renewal terms are.

  1. I’m not a happy camper with Kaiser MAPD….

    Yeah, but the care is poor and designed for cost savings at the patient’s expense. Here are our real life examples:

    Kaiser: loaner CPAP machine and get a personal CPAP
    Outside: overnight sleep study at a clinic covered in-network to properly diagnose the true extent of sleep apnea. Get CPAP.

    Kaiser: thyroid is on the low side of normal, but it doesn’t feel right. Kaiser PCP thinks all is OK.
    Outside: Armour thyroid treatment (Kaiser won’t prescribe this) in-network

    Kaiser: 2 months or more to get a psychiatry appointment and therapist. Only once every 2-3 months for both.
    Outside: Use a PPO to find an out-of-network psychiatrist that can take an appointment this week Same for therapist.

    ER doc: Shaking in the hands. Why aren’t you seeing a neurologist? You need to start seeing a doctor rather than come to the ER.

    Patient: But I have a Kaiser neurologist that I have for years and I saw last week and he has been unsuccessful at treatment.

    Kaiser: Thinks granny is a drug seeker. Granny has “medieval Game of Thrones torture” 12 out of 10 pain. Unable to get PCP to take her seriously.
    Actual: Unrelated surgeon found a huge sack of pus in the hip that has destroyed her hip joint and it was the source of her pain.

    Granny is on 25 concurrent prescription medications. I found that a good time saving way to push patients out the door is to prescribe meds. Granny doesn’t have the mental ability to question the wisdom of being on 25 meds concurrently or risk getting an opiate addiction.

    If you have easy to diagnose diseases, Kaiser works OK and it’s very convenient. It actually works fine for myself if I didn’t know any better.

    For members of my family who have difficult to treat diseases, it’s pretty piss poor. You don’t want to be sick and on Kaiser. It’s like choosing convenient McDonalds vs. a dinner service only steakhouse. McDonald’s rushes to serve you food within 2 minutes and it is edible. It’s also open 24 hours. It’s also very low cost. Steak place might be unaffordable especially if government is paying for a huge part of the bill.There you go, McD should get five stars even though it’s processed food crap because the crap is edible. In Norcal, Senior Advantage is very expensive with high copays and premiums. Why not just prepay with premiums on plan A/B/D/F, get no copays other than rx, and then choose the doctor of your choice that you can easily fire. You can’t fire a specialist at Kaiser without a ton of social engineering.

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