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Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

Dear Tom and Alan:

I know you guys are big on getting a Medicare supplement to go with your Medicare, but what about the Medicare Advantage plans that they advertise on TV?

I’ve been told that almost a third of the people on Medicare are on an Advantage plan rather than a supplement. They seem to devote entire channels to promoting them.

Are they that great?

Al: You are correct, Ed, our default position is if you can afford a Medicare supplement, that’s the best way to go.

Tom: However, we currently have two Advantage plans available in Napa County and we’re about to add two more for 2020.

For years. we’ve had SCAN, an Advantage plan in Napa and Sonoma counties. And, of course, Kaiser has been here for a very long time with their Senior Advantage plan.

The two new plans will be one from United Healthcare and one from Anthem Blue Cross.

Al: Kaiser, SCAN, and the new United Healthcare Medicare Advantage Assure plan are all HMOs.

In short, there is a limited network of providers and each person must have a Primary Care Physician (PCP). Coverage out of network is limited to emergencies.

We don’t have the details on the new Anthem, but for now we have the name: Anthem MediBlue Access PPO. The monthly premium is $26, with optional dental and vision plans for an additional cost.

Tom: The United Health plan is $25.60 per month (less if the person is on Medi-Cal). The copays for PCP and/or specialist visits are 20 percent. Usually this is a dollar figure so I’m not really sure what the exact cost is. Like many of the other Advantage plans, this one includes a prescription drug benefit.

Beyond original Medicare benefits, the United Healthcare Medicare Advantage Assure offers zero copays for routine physicals, eye exams and eyewear. There is a $2,500 credit for hearing aids.

There is no deductible and the maximum out-of-pocket amount is $6,700 annually for Medicare-covered services you receive from in-network providers. If you happen to reach the $6,700, you only have to continue to pay premiums and prescription costs.

Al: We’ve had other Advantage plans in Napa that have just gone away. I remember Secure Horizons, Freedom Blue and PacifiCare.

With open enrollment occurring each year from Oct. 15 to Dec. 7, one can always change from one Advantage plan to another, or from one drug plan to another.

And, if your Advantage plan does go away, you can apply for anything and get it.

Tom: We are not allowed to sell the Kaiser Senior Advantage plans, but I just saw that the cost for the plan is currently $94 per month with an option to add dental for $20 more.

Kaiser is not as geographically limited as the other three plans, and is the only plan rated five stars by the Center for Medicare and Medicaid Services (CMS).

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Submit questions to schrette@gmail.com or alancash@gmail.com.

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