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Dear Tom and Alan: Looking at the back page of the main section of the Napa Valley Register for Friday, Oct. 10, lo and behold there is a full-page ad for the SCAN Health Plan. It says it’s a Medicare Advantage health plan for Napa County residents.

The thing that caught my eye (other than the fact that it covers the whole page) was the monthly premium is zero. Now I’m no spring chicken, so you know I’ll be skeptical about something for nothing. How can this be?

P.S. $5 office visits?

Doubter

Tom: Yes, Doubter, SCAN is new to Napa and Sonoma counties for 2015. We haven’t had a Medicare Advantage plan available in Napa for a few years, except for Kaiser Senior Advantage. Freedom Blue, from Anthem Blue Cross was the last large one that went away. SCAN is advertised as a Health Maintenance Organization (HMO) so a member would be assigned a primary care physician through whom all care and referrals would be managed.

Al: It’s important to be aware that SCAN is not a Medicare Supplement plan. A “medsup” has all doctor bills go to Medicare first, then to the insurance company, then to the patient. Usually this type of plan has no office visit payments, co-pays, deductibles, or most other charges.

Advantage plan bills go directly to the insurance company. Medicare is not billed, so all arrangements are between the patient and the company.

As agents, the worst drawback of an Advantage plan is that they can leave from one year to the next forcing our customers to go scrambling for coverage. I remember clearly when Secure Horizons was popular in Napa, then it left.

Tom: Although Medicare is not billed directly in an Advantage plan, you can be sure that Centers for Medicare and Medicaid Services is looking over SCAN’s shoulder making sure they comply with all Medicare requirements. Also, in order to apply for SCAN, one must have Medicare A & B in place. Now that we’re a week into the Annual Enrollment Period (AEP), anyone can apply for SCAN. The AEP goes from Oct. 15 to Dec. 7 each year. During this period, people with Advantage plans or drug plans can change to a different plan to go into effect on Jan. 1. Of course, someone just turning 65 and new to Medicare can apply throughout the year.

Al: On Thursday, Oct. 23, Tom and I will be at the final certification meeting to be able to market SCAN. We hope to be able to answer a number of questions:

  • How big is the network of doctors going to be?
  • Which doctors?
  • Is a drug plan included?
  • Are there deductibles?
  • Does it work when traveling?
  • Are there charges for hospital stays?
  • Is there a maximum out-of-pocket expense?

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Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511; schrette@gmail.com; or alancash@gmail.com.

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