Sempra Breaking Down the Parts of Medicare

'For Sempra workers reaching retirement age, it is important to know the ins and outs of Medicare options, including Original Medicare and Medicare Advantage, to control long-term healthcare costs and to make sure that you can get the care you need without having to worry about surprise out-of-pocket expenses.'

'Sempra employees should carefully evaluate their Medicare options because choosing the right plan affects not only the availability of care but also plays a significant role in the company's financial situation during retirement.'

In this article, we will discuss:

1. Overview of Original Medicare and its components.

2. Difference between Original Medicare and Medicare Advantage Plans.

3. The need to comprehend the available coverage and select the appropriate plan for the needs of your health.

4. General Description of the Medicare Parts A, B, C, and D programs.

The different Medicare parts provide coverage for particular services. Most beneficiaries are enrolled in Original Medicare, which is the traditional fee-for-service program provided by the federal government for Parts A and B. It is also referred to as Traditional Medicare or Fee-for-Service Medicare (FFS). The government pays directly for your health care services under Original Medicare. You can visit any doctor or hospital in the United States that accepts Medicare because the majority of them do.

In Original Medicare:

When you need medical attention, you go to the specialist or hospital right away. You don’t need a primary care physician or approval from your primary care physician to see your specialist or hospital under Medicare. You will be required to pay a monthly Part B premium; some people also pay a Part A premium. Each service received will usually require a coinsurance payment. There are restrictions on how much physicians and hospitals can charge for medical care.

If you want prescription drug coverage under Original Medicare, you will have to select and enroll in a Medicare private drug plan (PDP) provided by a Medicare-approved private company. Note: If you meet the eligibility requirements, several government programs may help you lower your healthcare and prescription drug expenses. Unless you decide to opt out, you will be covered by Original Medicare.

You can receive your Medicare benefits from a Medicare Advantage Plan, also referred to as Part C or a Medicare private health plan. Remember that if you join a Medicare Advantage Plan, you will still have Medicare. This means that you still have to pay the monthly Part B premium (and the Part A premium if applicable). Every Medicare Advantage Plan has to provide all the services that are covered under Original Medicare, but it does so in a different way and with different restrictions that may affect when and how you can get the care you need.

It is crucial to understand your Medicare coverage options and make a decision about your coverage. The source of the benefits you receive and how you receive them can affect how much you pay out of pocket and where you can get treated. For example, in Original Medicare, you can consult with any doctor in the United States and go to any hospital. On the other hand, Medicare Advantage Plans have network restrictions, which mean that you will be able to see your doctor or go to the hospital that is part of the network. However, Medicare Advantage Plans can also provide services that Original Medicare does not, like yearly vision and dental care.

© 2019 Medicare Rights Center. Reprinted with permission. It is based on sources that it considered to be reliable and which provide true information. This material is not intended to serve as tax or legal advice. It is prohibited from being used to evade federal tax penalties. Please consult with a legal or tax professional for information specific to your situation. This content was developed and produced by FMG Suite to provide information on a potentially interesting topic. FMG, LLC has no relationship with the specified broker-dealer, state-registered investment advisory firm, or SEC-registered investment advisory firm. The opinions expressed and materials provided are for informational purposes only and should not be construed as an offer to buy or sell any security. Copyright FMG Suite.

Interesting and Surprising Facts About Medicare
Did you know that Medicare covers certain preventive services at no cost to you? This means that Sempra employees should be aware that under Medicare, you can get various preventive care screenings, vaccines, and educational services to help prevent and detect diseases early. These services include, but are not limited to, mammograms, colonoscopies, flu shots, diabetes screenings, and cardiovascular disease screenings. It is, therefore, important that you take the preventive services offered by your plan to help you prevent diseases and detect them early. Source: Centers for Medicare & Medicaid Services (CMS), 'Medicare Preventive Services' (last reviewed: October 2021).

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Metaphor: Medicare:

A Health Care Safety Net for the Retiree
Medicare is like a comprehensive toolbox that helps protect your health and well-being as you navigate the challenges of retirement. Just as a toolbox has various tools for certain jobs, Medicare has its components to address particular healthcare needs. Original Medicare is like the basic tools and provides the basic benefits and lets you go to any doctor or hospital that accepts Medicare. It is like having a screwdriver and a hammer at your disposal. On the other hand, Medicare Advantage Plans are like the specialized tools that come with additional features such as dental and eye care. They may have some drawbacks, but they offer a focused way of working to meet your individual requirements. Whether you like the idea of the toolbox or the tools themselves, knowing your Medicare coverage options helps you pick the right tools for your healthcare.

Sources:

1. Centers for Medicare & Medicaid Services (CMS).  'Compare Original Medicare & Medicare Advantage.'  Medicare.gov , U.S. Department of Health and Human Services, October 2021,  www.medicare.gov .

2. Humana.  'Original Medicare vs. Medicare Advantage: Which Should I Choose?'  Humana , 28 Mar. 2024,  www.humana.com .

3. Centers for Medicare & Medicaid Services (CMS).  'Understanding Medicare Advantage Plans.'  Medicare.gov , U.S. Department of Health and Human Services, October 2021,  www.medicare.gov .

4. Primary Immune.  'Take Time to Compare Original Medicare Versus Medicare Advantage.'  Primary Immune , October 2021,  www.primaryimmune.org .

5. The Commonwealth Fund.  'Traditional Medicare or Medicare Advantage: Older Americans' Choices.'  The Commonwealth Fund , October 2022,  www.commonwealthfund.org .