According to reports, PAMF is defining “existing patient” to mean someone who has been seen by their doctor within the last three years. Here’s my suggestion: Find your doctors(s) before you apply to Medicare and solidify the relationship by making sure you have been seen within the last year or two. While that leaves a healthy 98.5%, the recent Sutter/PAMF reports could be a game-changer.Įven Medicare Advantage (HMO) plans require you to designate a Primary Care Physician on your enrollment application. The Kaiser Family Foundation published an issue brief in 2020 that estimates 1.5% of California doctors have formally opted out of Medicare. When I suggest “Find A Doctor” I am alluding to the recent development of some doctors shying away from traditional Medicare. Lots and lots of client references– ask for them or check YELP or both.Represents at least four standalone Part D prescription drug plans.Represents at least five Medicare Supplement (medigap) plans.Represents at least three Medicare Advantage plans.Here are my best practice suggestions for choosing a local, independent agent: New plans are coming and going every year. Plus, Medicare Advantage and standalone prescription drug plans are contracted on a county by county basis. Chances are good that local agents know your county better: They hear and know what’s going on with local doctors and medical groups e.g.Sutter/ PAMF, SCIPPA, PMG. You are going to need their help over the years because insurance companies have a tendency to bring new plans into the county and close older plans as time goes on.īy local, I mean an agent who is not out of state and not digital (online only). When you find one, treasure that relationship, because good agents get booked up quickly through referrals. However, not every agent is independent and not every independent agent represents a large number of plans. So there is really no incentive to favor one plan over another. Medicare sets the compensation dollar amount and for Medicare Advantage plans, it is the same from insurer to insurer. In fact, they are only compensated when they help you complete an enrollment application for insurance coverage. Local Independent agents do not charge fees, using them does not add to the cost of your insurance. How do Independent Agents Get Compensated? However, these rights do not apply in all circumstances and you should seek a consultation from a competent independent agent before enrolling. When you enroll in a Medicare Advantage plan for the first time, you may have Medicare “trial” protections and additional rights under California law, which could allow you to return to traditional Medicare with supplemental (medigap) coverage. Find a local, experienced Independent Agent, representing lots of insurance companies.Find your doctors well before applying for Medicare.Best Practices for individuals approaching Age 65 Another recommendation is… find a doctor, before you apply to Medicare. guarantees that you can return to traditional medigap coverage) would apply to your situation. Make sure you discuss what, if any, trial rights (i.e. If I were to develop a list of best practices to research the issue, it would begin with finding a competent, local independent agent whom you are comfortable I would answer you first need a lot of information, including understanding the risks of Medicare Advantage plans. Before You Test Drive Medicare Advantage Plans Before you “drive,” first, get independent advice, locally. Some individuals are doing a test drive, in order to gain access to Sutter/ PAMF. Stanford Medicine and Palo Alto Medical Foundation have popular Medicare Advantage plans in Santa Clara valley. So if your current physician is contracted with a Medicare Advantage plan…or if you are willing to try one of these plans, in order to gain access to Sutter/PAMF, should you give it a test drive (note: the number of plans is expanding in 2023- see related story)? This statistic has been growing for years. Yet, Stanford Medicine offers fewer choices in Medicare Advantage.Īccording to the Kaiser Family Foundation, in 2021 42% of Medicare beneficiaries nationally have chose a Medicare Advantage plan over traditional Medicare. There is a buzz about reports that Sutter/ PAMF (Palo Alto Medical Foundation- formerly Camino Medical Group, Sunnyvale Medical Clinic etc.) is limiting access to new Medicare patients on traditional Medicare (read story). Are recent events tempting you to test drive any of the Medicare Advantage plans in Santa Clara valley? It seems more and more doctors are shying away from traditional Medicare (original Medicare Part A and Part B) in Santa Clara valley.
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