Frequently Asked Questions About Medicare
Understanding how Medicare works and making decisions about your Medicare coverage options can be confusing and overwhelming. At Sharp HealthCare, we are here to answer your questions and guide you step by step to enrollment.
Are there any Medicare resources available?
At Sharp, we offer the following free Medicare resources to all patients:
What should I consider when choosing a Medicare plan?
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
What are the differences between a Medicare Advantage plan and a Medicare Supplement plan?
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 view a list of Medicare Supplement plans and their monthly premium costs, visit the Medicare website.
What is the cost of Medicare Part A and Medicare Part B?
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 2019 is $135.50 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.
Do Medicare Parts A and B include drug coverage?
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.
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.
What is a Medicare Advantage (Part C) plan?
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.
What is a Medicare Supplement (Medigap) plan?
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.
Is there is a penalty if I have had Medicare Parts A and B, but no Part D drug coverage?
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.
What Medicare plans are accepted by Sharp?
When you select one of the plans listed below, you'll have access to the skilled and compassionate caregivers at Sharp.
- Original Medicare
- All Medicare Supplement (Medigap) Plans
Sharp Health Plan Individual Medicare Advantage Plans*
- Sharp Direct Advantage Gold Card (HMO)*
- Sharp Direct Advantage Platinum Card (HMO)*
UnitedHealthcare Individual Medicare Advantage Plans*
- Sharp SecureHorizons Plan by UnitedHealthcare (HMO)*
- AARP MedicareComplete SecureHorizons Value (HMO)*
- AARP MedicareComplete SecureHorizons Premier (HMO)*
- AARP MedicareComplete SecureHorizons Essential (HMO)*
- TRICARE for Life
- Health Net Seniority Plus Group Retiree Plan*
- Sharp Health Plan Group Retiree Plans*
- Sharp Direct Advantage for former employees of Sharp HealthCare
- Sharp Direct Advantage for retirees of the City of San Diego
- UnitedHealthcare Group Retiree Plan*
*These plans are Medicare Advantage organizations with Medicare contracts, and enrollment in one of these plans will depend on contract renewal.
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
Do I need to enroll in the health insurance exchange, Covered California?
If you have Medicare, you do not need to worry about the open enrollment period for Covered California.
Ready to enroll?
Ready to enroll in a Medicare Advantage plan accepted by Sharp? Select a plan below to learn more.
Sharp only accepts the Health Net Seniority Plus Group Retiree Plan. We do not accept any Health Net individual Medicare Advantage plans. If you are a Health Net Seniority Plus Group member, please visit Health Net to review your benefits. If your employer offers the Health Net Seniority Plus Group Retiree Plan, contact your benefits administrator to enroll.
Medicare Open Enrollment
We walk you through evaluating your coverage and choosing the Medicare plan that’s right for you during annual open enrollment.
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