Medicare Advantage

Every Medicare eligible person needs to make a choice about the health plan coverage that is right for them.

If you see a Physicians Medical Group doctor, you can rest assured that 100% of them accept Medicare Advantage health plans. Other Medicare plans may not be accepted. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. Medicare Advantage Plans offer you patient-centered, coordinated care, with a focus on wellness and preventive care. Your doctor is your partner in health care. Discussing your referral needs with your primary care physician allows him or her to coordinate the care you receive from specialists, hospitalists and therapists. This relationship is particularly valuable if you are managing a new or chronic condition.

All PMG primary care physicians and specialists accept Medicare Advantage Plans so you don’t need to worry about finding a physician who accepts your coverage. All PMG physicians accept the following Medicare Advantage Plans for 2016:


Community meeting dates

Most Medicare Advantage Plans host community meetings throughout the year and during the Annual Election Period, October 15-December 7. If you have questions about these local community meetings call the PMG Patient Care Coordinators at (831) 465-7800 or contact the PMG Medicare Advantage Patient Liaison at (831) 465-7888.


Resources

We know that it can be confusing to sift through health plan information. To educate yourself about your options consider exploring some of the following resources:

PMG Medicare Advantage Patient Liaison – Meet Debbie Reed

PMG’s Medicare Advantage Patient Liaison, Debbie Reed, is available to you if you have questions about Medicare Advantage Plans or Physicians Medical Group. The PMG Medicare Patient Liaison can provide objective information about health plan benefits, how Medicare Advantage Plans work and how to enroll. Call (831) 465-7888 to learn more.

Senior Network Services Health Insurance Counseling and Advocacy Program (HICAP)

HICAP is offers complimentary, objective health plan counseling services to people with Medicare. They are located in Santa Cruz and in Watsonville. Call (831) 462-5510 to make an appointment or to learn more about their free services.

PMG Patient Care Coordinators

PMG Patient Care Coordinators are located right here in Santa Cruz and you won’t have to go through a massive phone tree or wait on hold forever. Most of our Patient Care Coordinators are bilingual and have worked at PMG for years, so they actually know our doctors and can help you with your questions. Just call (831) 465-7800.

Broker

If you have a relationship with an insurance broker, contact them and set up an appointment to discuss your options. Consider bringing a list of your medications and the names of the physicians that you see. You will also want to mention if you receive your prescription drugs through the Veterans Affairs (VA) or TriCare, if you currently receive coverage through an employer or union health plan or if you think you may qualify for a low income subsidy.

Community Meetings

Most Medicare Advantage Plans host community meetings facilitated by either a plan representative (employee) or a licensed insurance broker. The meetings give you the opportunity to learn about health plan benefits, ask questions and enroll if you wish.

Medicare Advantage Plans

Medicare Advantage Plan representatives are available to answer your questions. Most plans have regional representatives who can meet with you in person or speak with you over the phone to discuss plan benefits, address your needs and questions and provide enrollment assistance if you wish. In addition, plan websites usually offer detailed information on plan benefits and a list of covered prescription drugs (formulary).

Medicare

Call 1-800-Medicare (24 hours a day/7 days a week) or visit their website, www.medicare.gov. The Medicare website allows you to compare Medicare health and prescription drug plans, find out if your prescription drugs are covered and compare costs and even enroll.

Employer Or Union

This is important. If you have coverage through your employer or union, contact them before you change health plans. Often current or former employees who disenroll from an employer or union provided health plan are unable to re-enroll in that coverage once they have opted out.