San Diego Gas & Electric Employees: Medicare Advantage 101

Healthcare Provider Update: San Diego Gas & Electric (SDG&E) primarily offers healthcare coverage for its employees through various health insurance providers, including major players in the market such as Anthem Blue Cross and Kaiser Permanente. These providers typically offer a range of plans that cover various medical needs, including preventive care, hospital visits, and prescription medications. As we approach 2026, significant healthcare cost increases are anticipated for SDG&E employees. With the potential expiration of enhanced federal premium subsidies under the Affordable Care Act, many policyholders may see their out-of-pocket costs skyrocketing by over 75%. Increased medical costs, driven by rising hospital and prescription drug prices, combined with aggressive rate hikes from insurers, could lead to premium increases of up to 66.4% in some states. This perfect storm of factors will pose a substantial financial challenge for workers relying on employer-sponsored healthcare plans. Click here to learn more

Medicare Advantage, sometimes known as “Part C,” is something of a catch-all choice for San Diego Gas & Electric employees who are ready to sign up for Medicare. Medicare Advantage plans are offered by private insurers in conjunction with the Medicare program and can provide you with additional health insurance coverage.

What’s in them?
In addition to signing up for Medicare Part A (hospital stays) and Part B (medical coverage), Medicare Advantage plans offer their subscribers extra features. This frequently, but not always, includes the Medicare Part D prescription drug plan. In some cases, Medicare Advantage plans offer coverage for areas not normally offered within regular Medicare plans. This can include dental, hearing, and vision insurance.

What are the rules?
Medicare pays for a fixed amount of your health care to San Diego Gas & Electric offering your Medicare Advantage (MA) plan. Beyond that, each MA plan requires different out-of-pocket fees. Those fees can vary from plan to plan. Depending on your plan, you may have different rules you need to follow when seeking a medical referral to get treatment from a specialist or if you are seeking non-urgent care (even from health care providers within the plan). It’s also important to remember that rules, requirements, and features may change from year to year. It will be important to make sure that those changes line up with any treatment that you need.

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What about my prescriptions?
While most MA plans offer Part D coverage for prescription drugs, some don’t. One example would be Medicare Medical Savings Account plans. In cases where the plan can’t or chooses not to offer prescription drug coverage, you may have the ability to join a separate Medicare Prescription Drug Plan, depending on the type of plan you enroll in. You will likely have a number of questions and concerns as you examine your options for Medicare Advantage plans. Discuss these with a trusted financial professional who can help you make choices that may best fit your lifestyle.

1. Medicare.gov, 2022