Insight Family Health - Good Health Starts Here

Medicare is the federal health insurance program primarily for people age 65 and older, along with certain younger individuals with disabilities or specific conditions. It’s divided into parts: 

Traditional Medicare: (Part A & B Combined)

• Part A covers hospital care (Cost $0/mo) 
• Part B covers outpatient and physician services (Cost $185/mo)

Part B cost is usually deducted from your social security payment, no bills.

While Medicare provides broad coverage, it does not pay for everything—patients are still responsible for deductibles, copayments, and coinsurance unless they have supplemental coverage. Understanding how these parts work together is key to avoiding unexpected costs and choosing the right coverage. 

Typical Path

For the typical case (turning 65 and not actively working with employer coverage), people sign up for both Part A & B together during their initial enrollment period.  That gives them full “Original Medicare” coverage—hospital (Part A) and outpatient/physician (Part B)—from day one. 

Medicare Supplemental Plans (aka: "Medigap"): 

Cost: ($120-$300/mo. cost). 

Medicare Supplement plans are formally called “Medigap plans” and are an add-on to Traditional Medicare for extra cost, but covers most of deductibles, coinsurance, and copays, and sometimes prescription drugs. The goal is simple: near-zero surprise bills and full access to any provider nationwide that accepts Medicare, with no networks or referrals limits like Advantage Plans (see #2, below).

There are various levels of coverage available in supplemental plans and they are designated by a range of letter designations (A–N).  Do not confuse these Medigap A-N letter designations with Medicare Parts A, B, C & D.

The Medigap A-N designations are a separate set of guidelines that correspond to a list of individual benefits A-N as defined by Medicare.

—so a Plan G in one plan offers identical coverage to a Plan G at any other insurance company.

(See image below of A-N benefits)

Medicare Advantage Plans (aka: "Part C")

This is a private insurance alternative that entirely replaces Part A & B. with a private insurance plan, also known as Part C.  If you get such a plan it may be cheaper than Traditional Medicare ; however they come with more restrictions and oversight of the doctors orders (prior approval required for many orders, referrals etc) and a more limited network of approved doctors. If you get one of these plans it replaces your Medicare A/B card and becomes your primary insurance that you provide during any medical visits.

Prescription drugs (aka: "Part D")

This coverage is usually included in a Supplemental Plan (Medigap), or a Advantage Plan (aka: "Part C"), but can also be purchased as a stand-alone plan for patients with only Traditional Medicare.

Our recommendation:

At Insight Family Health we serve as a Medicare Primary Care Physician in Sunnyvale, California.  While both Traditional Medicare (with a Supplemental Plan) and a Medicare Advantage Plan can be suitable for your needs, we recommend the following:

First Choice: Traditional Medicare with Supplemental from Blue Shield*. 

This option gives you much wider access to doctors and specialists. This becomes important if you develop health issues as it gives you the option of choosing the doctor that is near you (reduced travel challenges) and allows your doctor a wider range of referral options that do not require the prior approval of a private insurance administrator.  With more doctors to choose from you get access to care quicker. This is critical to positive outcomes. With less delays waiting for insurance's prior approvals (PA) and immediate access to specialists with schedule availability it is well worth the extra cost.

*Other Options

AARP/UnitedHealthcare (dominates market share ~65%)

Anthem Blue Cross (strong regional presence)

Blue Shield of California (local brand + stability)

Second Choice:  Advantage Plan from Alignment Health Care*

If your primary motivation is to save money, Advantage Plans may be worth a look.  We recommend Alignment HealthCare because we have many patients with this private plan who are highly satisfied.

*Other Options

Humana is an excellent plan, but may not be available in your area

We recommend that you consult a professional insurance broker/advisor to understand all your options before committing to any choice.

Insight Family Health provides a high level of service with every Medicare patient's visit; allocating one hour for first visits and 40 minutes for follow ups. We will also see you as often as necessary according to your health needs. These visits are much longer and more comprehensive then any standard Medicare defined free visits. 

However patients with ONLY TRADITIONAL MEDICARE, who do not have full coverage, may be interested in two types of free visits that are pre-designated by Medicare as free. These visits are more limited in scope then a normal visit to our office but offer a great and economical option for such patient's health needs.

Types of Medicare Defined Free Visits:

[1] Welcome to Medicare Exams

[2] Medicare Annual Wellness Visits

Our team is dedicated to helping you and your family feel better, faster, and to providing the highest level of care for all ages. If you have concerns about Medicare Benefits available at Insight Family Health or any other health issues, please don’t hesitate to reach out!  Call our office or simply schedule an appointment online.