Medicare Q&A

Medicare is not a one size fits all, and we want to equip you with the knowledge and tools to navigate the health system.

Intro to Medicare Part A&B.

Medicare Part A focuses on hospital-related expenses, while Part B covers medical services and supplies. Both parts work together to provide a basic level of health coverage for eligible individuals.

What is Medicare Part C?

Medicare Part C plans combine the benefits of both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and often include additional coverage, such as prescription drug coverage (Medicare Part D) and sometimes even extra benefits like dental, vision, and fitness programs.

What is Medicare Part D?

Medicare Part D specifically focuses on providing coverage for prescription drugs. It was introduced in 2006 to help beneficiaries of Medicare (Part A and/or Part B) afford the costs of their prescription medications. Part D plans are offered by private insurance companies that are approved by Medicare, and they work alongside the original Medicare coverage (Part A and Part B) or Medicare Advantage plans (Part C).

What is a Medicare Supplement?

A Medicare Supplement, also known as a Medigap plan, is a type of health insurance policy designed to help cover the gaps or “gaps” in coverage that original Medicare (Medicare Part A and Part B) might not fully pay for. Original Medicare covers a significant portion of medical costs, but there are still out-of-pocket expenses such as deductibles, copayments, and coinsurance that beneficiaries are responsible for.

What is a Medicare Broker?

A Medicare insurance broker or agent, is a licensed professional who assists individuals in navigating and selecting the most suitable Medicare plans for their healthcare needs. Medicare is a federal health insurance program in the United States primarily designed for individuals who are 65 years of age or older, as well as certain younger people with disabilities.

How Does a Broker Get Paid?

Medicare insurance agents or advisors, help individuals navigate the complex world of Medicare and assist them in finding suitable Medicare insurance plans that match their needs. These brokers typically get paid through commissions from insurance companies.

How do I Sign Up for Medicare?

Initial Enrollment Period (IEP) is the 7-month period that includes the three months before you turn 65, the month of your 65th birthday, and the three months after your birthday. You can apply for Medicare online through the Social Security Administration (SSA) website. Create a “my Social Security” account or log in to an existing account and follow the instructions to apply.

Penalties That May be Imposed.

Medicare penalties can refer to the financial consequences that individuals may face if they do not enroll in certain parts of Medicare when they are eligible or if they do not follow specific rules and guidelines. Here are a few instances where Medicare penalties might apply.

How to Connect with a Medicare Broker.

To get connected to a Medicare broker, reach our to our Patient Relations team! Our Patient Relations team will come alongside you to make sure there are no hiccups along the way. When you become a patient, they are here to serve YOU, our senior community and be available for insurance based questions throughout the duration of your care. Call now! (805) 702-8337

Is Medicare Advantage right for you?

5 Reasons to consider Medicare Advantage

1. Less spent on health care compared to original Medicare and supplement plans

Many Advantage Plans, if not most, offer low (or no) deductibles and no premiums. Most Medicare Advantage plans also set an out-of-pocket limit each year. As if that wasn't enough, a study was published in the Journal of American Medical Association that found that those who were on Medicare Advantage plans spent significantly less on lab services and medical equipment.

2. Advantage Plans include non-Medicare benefits like vision, hearing, and dental

Straight Medicare includes part A (hospital insurance) and part B (medical insurance). Medicare Advantage plans are called part C, which usually includes benefits that straight Medicare does not cover. This can include benefits like dental, vision, hearing, transportation, gym privileges, chiropractic care, and more!

3. Advantage Plans include medication coverage

In addition to Medicare part A and B, there is also Medicare part D, for drug coverage. Part D is almost always covered under a Medicare Advantage plan, so you will have all of your medicines covered and have no need to purchase a Part D plan!

4. Coordinated care between primary care provider, specialists, and hospitals

Medicare Advantage makes taking care of your health easy! When you have a Medicare Advantage plan in Ventura county, you can be assigned to us as your primary care provider. We work very closely with any specialists that you see through Seaview to make sure that everyone is on the same page for your health needs.

5. All PMG doctors accept Medicare Advantage Plans

Many of our most popular doctors have closed patient panels due to high demand. However, if you have a Medicare Advantage plan, all doctors are ready and available to take care of your needs!

Accepted Insurances

Medicare and Medicare Advantage Plans:

Anthem MediBlue Plus (HMO)
Anthem MediBlue Prime (HMO)
Anthem MediBlue Dual Advantage (HMO D-SNP)
Anthem MediBlue Dual Plus (HMO D-SNP)

AARP Medicare Advantage
SecureHorizons (HMO-POS)
AARP Medicare Advantage Patriot (HMO-POS)
UnitedHealthcare Chronic Complete (HMO-POS C-SNP)
UnitedHealthcare Chronic Complete Focus (HMO C-SNP)

Humana Gold Plus (HMO)
Humana Gold Plus SNP-DE (HMO D-SNP)
Humana Honor (HMO)

Blue Shield 65 Plus (HMO)

Classic HMO

Wellcare No Premium (HMO)
Wellcare Giveback (HMO)

We accept all PPO plans, including Tri-Care, if we are in network with your provider. Please call your insurance provider to make sure. Unfortunately, we are not able to check on our end.

If you do have any questions, please callĀ (805) 702-8337