Frequently Asked Questions About Medicare

At Sharp, we offer the following free Medicare resources to all patients:

• Videos — Get answers to the top Medicare questions on your schedule with our educational videos.
• Expert advice over the phone — If you prefer to talk with someone privately, call us at 619-473-4465, Monday through Friday, 7 am to 7 pm.

When you are evaluating your coverage options, it is important to review the following:

• Number of times you visit the doctor in a year
• Plan benefits and monthly premium
• Relationship with your current doctor
• Hospitalization cost
• Drug coverage vs. Part D plan
• Any additional services, such as fitness, dental or worldwide coverage

The biggest differences between Medicare Advantage and Medicare Supplement plans are network and cost. Medicare Advantage plans are HMOs or PPOs where you have a network of doctors and hospitals to choose from for your care. Medicare Supplement plans allow you to go to any doctor or hospital that accepts Medicare. Medicare Advantage plans offer low or $0 monthly health plan premiums beyond what you pay for Medicare Part B. Medicare Supplement plans supplement your Original Medicare benefits. To learn about plans and their monthly premium costs, visit Sharp Health Plan or United Healthcare, which offer Medicare Advantage plans accepted by Sharp.

Watch our Medicare Supplement and Advantage Plans Video to learn more.

You usually do not pay a monthly premium for Medicare Part A (inpatient/hospital insurance) coverage if you or your spouse paid Medicare taxes while working. You pay a monthly premium for Medicare Part B (outpatient/medical insurance), which is based on your IRS tax return from two years prior.

The standard Part B premium amount in 2020 is $144.60 per month. Depending on your income, you may pay more. In addition to your monthly premium(s), Parts A and B of Medicare also have deductibles and co-insurances you are responsible for paying.

If you would like to have drug coverage, you may choose a Part D plan, which covers only drugs, or a Medicare Advantage plan (Part C) that includes drug coverage. Visit Sharp Health Plan or United Healthcare, which offer Medicare Advantage plans accepted by Sharp.

Medicare Part A does not include drug coverage. Medicare Part B generally doesn't cover most prescription drugs used at home, but it does cover a limited number of outpatient prescription drugs under limited conditions. Generally, drugs covered under Part B are drugs you wouldn't usually give to yourself, like those you get at a doctor's office or hospital outpatient setting.

These plans also provide financial protection through annual limits on out-of-pocket expenses. Medicare Advantage plans offer a low or no-cost monthly health plan premium beyond what you pay for Part B and give you access to care from doctors and hospitals that are within the plan's network. To find out which doctors are included in the network, contact Sharp Health Plan or United Healthcare, which offer Medicare Advantage plans accepted by Sharp.

Medicare Advantage (or Part C) plans are offered through private insurance companies and provide you with your Medicare Part A and Part B benefits. They also include prescription drug coverage and may include additional benefits like vision, hearing and dental. These plans may offer low or $0 monthly health plan premiums beyond what you pay for Medicare Part B outpatient coverage.

Watch our Medicare Advantage Part C Video to learn more.

Medicare Supplement or Medigap insurance is a plan offered through private insurance companies that can help pay for some of the costs that Medicare Parts A and B require you to pay. This would include copayments, coinsurance and deductibles. Medicare Supplement plans supplement your Original Medicare benefits. When you have a Medicare Supplement plan you can continue to go to any doctor or hospital that accepts Medicare.

Watch our Medicare Supplement Insurance Plans Video to learn more.

If you have Medicare, but have not had Medicare prescription drug coverage, or other creditable prescription drug coverage (such as from an employer or union, which is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage) for any continuous period of 63 days or more after your initial enrollment period is over, you may owe a late enrollment penalty.

The late enrollment penalty is calculated by multiplying 1 percent of the "national base beneficiary premium" ($33.19 in 2019) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D plan premium. The national base beneficiary premium may increase each year, so your penalty amount may also increase each year. In general, you'll have to pay this penalty for as long as you have a Medicare drug plan.

Watch our Medicare Part D Video to learn more.

When you select one of the plans accepted by Sharp, you'll have access to our skilled and compassionate caregivers.

No matter which plan you choose, as a Sharp patient, you will receive:

• Convenient access to Sharp medical offices and urgent care centers, plus Sharp hospitals and emergency departments
• Coordinated care provided by a primary care doctor working in partnership with you and specialists to maintain your optimal health
• Clinical excellence delivered with understanding and compassion — a level of care we call The Sharp Experience

If you have Medicare, you cannot apply for coverage through Covered California because Medicare is considered minimum essential coverage under the Affordable Care Act. Also, Covered California does not offer Medicare Advantage plans or any Medicare supplemental plans such as Medicare Part D.