Guest editorial: Searching for a Medicare Advantage Plan?

Posted: October 7th, 2016 | Opinion, Opinion & News | No Comments

By Paul Downey

The Medicare Open Enrollment Period is fast approaching. From Oct. 15 to Dec. 7, current Medicare users can adjust or change plans to ensure access to the services the best fit their needs.

With hundreds of private insurance companies trying to convince you of what you really need, here are some questions to help with your search.

1. What is the different between Original Medicare and Medicare Advantage?

medical_care_card_sample-wikimedia-commonsOriginal Medicare is two parts: Part A covers hospitalization, skilled nursing care facilities after a qualifying hospital stay, hospice, and medically necessary nursing home care and home health services, and Part B covers medical expenses and preventative services.

Instead of Original Medicare, you can purchase a Medicare Advantage Plan (Part C). These alternative plans, offered by private insurance companies, often include prescription drug coverage and cover more services than Original Medicare, such as vision and health and wellness programs.

A prescription drug plan (Part D) is available to everyone with Medicare. Part D plans vary in cost and the types of prescriptions that are covered. If you choose not to enroll in Part D when you are first eligible, and do not have a creditable drug prescription coverage, you may have to pay a late enrollment fee if you join later. Creditable prescription drug coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Examples include current or former employer or union coverage, TRICARE, the Indian Health Service, or the Department of Veterans Affairs.

2. What is the price difference between plans?

Original Medicare Parts A and B have the same premiums and coverage across the nation. If you choose a Medicare Advantage or Part D plan, there are many options to consider. The least expensive policy may not be the best value based on your situation. The State Health Insurance Assistance Program (SHIP) can help you navigate through all of your options.

3. Can I still see my current physician if I switch plans?

With Original Medicare, you can see any doctor who participates in the Medicare program and receive care at any hospital nationwide. With a Medicare Advantage Plan, you may or may not be able to choose your doctor or hospital, depending on the type of plan. Talk to your doctor about potential issues before you make the switch.

4. Is there help to pay for Medicare if you have a limited income?

People with limited incomes and resources may be eligible for help paying their Medicare premiums and deductibles. If your income is less than $17,820 if single and $24,030 if married, you may also qualify for Medicare Rx Extra Help to cover prescription drugs. The National Council on Aging (NCOA) Benefits CheckUp is a resource to find benefit programs that could help you pay for healthcare and medications.

5. How do I know if I’m making the best choice?

No one can tell you which Medicare plan is right for you. However, the federal government provides an online plan finder that helps narrow down plans available in your area, and includes information such as a list of approved prescription drugs. Visit to learn more about this service. HICAP (Health Insurance Counseling & Advocacy Program) also provides free and objective Medicare counseling and education. Call 1-800-434-0222 for more information.

If you need help locating a resource, contact Serving Seniors’ Carlos Ochoa-Mendez at 619-487-0719.

—For more than two decades, Paul Downey has been the president and CEO of Serving Seniors, a nonprofit agency dedicated for more than 45 years to increasing the quality of life for San Diego seniors living in poverty. Learn more at

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