Medicare in Orange County: What you need to know
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Navigating the complex world of Medicare can be confusing. Seniors often have questions about the various plans, options, and when to apply. Timing is crucial, and what seems a small thing like making a change to your plan or joining a part of a plan you don’t know much about could negate your benefits.
To complicate matters, many people now work past the traditional age of retirement and are covered by an employer benefit plan.
To help patients understand their options, Edinger Medical Group offers senior care coordinators that can provide referrals to no-fee brokers who will do a side-by-side plan comparison of the various Medicare plans and options.
“So, even if it’s not a plan Edinger takes, Edinger wants it to be better for the patient, not better for Edinger, said Lara McKenna, Executive Director of Business and Patient Relations at Edinger Medical Group.
Who is eligible?
Older adults become eligible to apply for Medicare during an Initial Enrollment Period, a seven-month window that begins three months before their 65th birthday and ends four months after.
“At that time, you can get any Medicare plan under what is called Guaranteed Issue, and you do not have any pre-existing conditions to worry about,” said Robin Whyte, an Independent Contracted Agent who specializes in Medicare plans. “It is important to choose wisely because later you may not be able to enroll in a different kind of plan without going to underwriting.”
New applicants will be asked to choose between a Medicare Advantage Plan (HMO or PPO) or a supplemental plan called Medigap plus a standalone drug plan.
Whyte said when choosing their plan, seniors should ask themselves these questions: Do I have doctors and hospitals that I really want to have access to? Who are they contracted with? Do I want to have the ability to self-refer all over the United States, or am I satisfied to receive all my non-emergency services within one local network?
Low to zero premiums
As an agent who only offers Medicare plans, Whyte notes the benefits of the Medicare Advantage Plan that make it an attractive option.
“The obvious benefit of the Medicare Advantage plans is that the monthly premiums are usually zero versus premiums of several hundred dollars for a supplement and a standalone drug plan,” Whyte says.
She notes that some clients find this zero premium “too good to be true,” especially those who have never enrolled in an HMO plan.
“The reason the Medicare Advantage premiums are low or zero cost is that the government pays the Medicare Advantage providers a monthly fee to care for the patients,” Whyte explained. “Medicare providers that score well on patient outcomes receive more money to care for their patients.”
Another benefit is that Medicare Advantage groups coordinate patient service, Whyte said. “When you are on your own, it’s sometimes difficult to find primary care doctors who are accepting new Medicare patients, or to know the type of specialists you need.”
“If you pick a Medicare Advantage plan and some time goes by and you decide you want the Medigap plan, you may have to go to underwriting and you may be denied,” Whyte says. However, if you’ve enrolled in a Medigap plan and you decide you want the Medicare Advantage plan, you can enroll anytime during the annual enrollment period, which is Oct. 15th to Dec. 7th.
Another important decision for seniors is which medical group they designate to provide their Medicare Advantage care, because, unless it’s an emergency, they must receive all their medical services from this network.
“The better the medical group, the higher the Medicare Advantage client satisfaction,” Whyte said.
The Edinger advantage
Whyte said she often receives calls from new clients saying, “I need a Medicare plan, and I don’t care which one. I only care that I can keep Edinger Medical Group.”
“That’s how strong the bond is,” Whyte said. “This is often followed by how many years they have been an Edinger member, and their parents and grandparents before them. It’s generations of care and that builds trust,” Whyte said.
That may be the reason Edinger is one of the few medical groups in Orange County that has earned a five-star rating with Integrated Health Association (IHA) for the quality of care for Medicare Advantage patients.
Edinger also was ranked the number one medical group by Orange County residents for the fifth consecutive year and was the highest-rated group for clinical quality of care when compared to 228 other medical groups throughout the state.
“I’m impressed with the credentials of their doctors and a culture of compassion from the entire staff,” said Whyte.
With offices in Huntington Beach and Fountain Valley, Edinger Medical Group employs dedicated staff, accessible with direct phone lines, who help patients manage their prescription drugs, labs, and other senior concerns.
For questions about Medicare plans and options, call 714-965-2557 or visit edingermedicalgroup.com.