Medicare Resources

Free help, easy access

Scripps Affiliated Medical Groups offers a free brokerage service that specializes in Senior Health Insurance options all over San Diego County. Our broker partner, Caress Agency, conducts business here locally in San Diego and offers the ease of communicating all from over the phone. Caress Agency’s primary objective is to assist the Medicare eligible with their transition into a Senior Health Insurance plan. They deliver honest and unbiased comparisons of Medicare Supplemental Plans available because Caress Agency represents the top carriers in the Senior Health Insurance market.

Their licensed and certified Senior Health Insurance Specialists explain basic Medicare and the best way for the Medicare beneficiary to supplement it. They take doctor & hospital preference, prescription medications, price range and flexibility into consideration when helping the senior choose their health coverage.

 

Frequently asked questions

Medicare is a Federal Health insurance program that covers most people 65 years old and over, some people younger than 65 with disabilities, people diagnosed with amyotrophic lateral sclerosis (ALS), and those with end-stage renal disease.

Part A– Hospital insurance – Covers most in-patient hospital care, some in-patient skilled nursing facility care, some home health care, and hospice care. – There is no monthly Part A premium for people who have 40 or more quarters of Social Security credits (about 10 years of full-time work with four quarters per year) and who are eligible for Social Security or Railroad Retirement benefits.

Part B – Outpatient medical services – Covers a portion of the Medicare approved costs for out-patient medical services such as doctors’ services, out-patient hospital care, laboratory tests, out-patient physical and speech therapy, some home health care, ambulance services, and some medical equipment and supplies.

- Most people get Medicare when they turn 65

- Receive cards 3 months before

- Those who have been disabled for 2 years will also be enrolled into Medicare

- Typically, most seniors are automatically enrolled into Part A but have the choice of whether to enroll into Part B

Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that’s usually covered and your provider thinks that Medicare won’t cover it in your situation, you’ll have to read and sign a notice saying that you may have to pay for the item, service, or supply.

-Basic Medicare only covers 80% of the cost for Medicare covered services

- Basic Medicare does not include drug coverage

- So this leaves 20% of the cost and prescription costs to be paid out of pocket if someone does not have supplemental insurance

Medicare Advantage Plans
---- Acts as your primary insurance
---- County based plans
---- Network and non-network based plans available
---- Typically have drug coverage built into the plan
---- Special benefits such as acupuncture, gym memberships, transportation etc.

Medicare Supplement Plans
---- Acts as your secondary insurance
---- Covers the remaining 20% that Basic Medicare doesn’t cover
---- Flexibility, can be used nationwide
---- Non network based
---- No copays

Prescription Drug Plans
---- Often paired with a Medicare Supplement since those do not include drug coverage
---- Low premiums
---- Helps cover cost of prescriptions
---- Preferred and Mail Order pharmacy options

- For MAPD & PDPs you have 3 months before your birth month, the month of your 65th birthday, and 3 months after to enroll

- For Medicare Supplements you have 3 months before your birth month, the month of your 65th birthday, and 5 months after to enroll

- This period of time is called your Initial Enrollment Period in which you can sign up for a plan without answering any medical questions

- Enroll into MAPD or PDP during the Annual Enrollment Period (Oct 15th – Dec 7th) or if you have a Special Election such as moving counties or gaining or losing Medicaid status you can enroll into a plan

- Enroll into Medicare Supplement at any time of the year by undergoing medical underwriting, which is basically answering a series of medical questions

No, but if you both qualify for Medicare there are some plans that offer household discounts

- If you apply for a plan during your IEP, this will not affect your ability to be covered

- There are SNP plans available catered to certain health conditions