Medicare is a lot to wrap your head around, so if you don’t fully understand it, trust me you’re not alone. In this description I’m going to move forward as if you understand a lot of what Medicare offers. If that’s not you, please skip ahead to “Explaining Medicare’s Choices,” in this section we break down what Parts A, B, C, or D are and you’ll probably get a better feel for this rather confusing situation.
Sharp Medicare Advantage is a Part C plan that combines Parts A, B, and D, and offers additional coverage through Sharp. This plan covers most of your Part B coinsurances outright or replaces them with lower copayments. On top of that it offers a $1,500 out-of-pocket maximum, meaning that you’ll never have to spend more than that amount a year for covered healthcare.
This plan also covers vision service, therapy, 100 days in a skilled nursing facility, and much more. For a full list of covered services, check out the Summary of Benefits guide linked here.
Explaining Medicare's Choices
There are a lot of choices surrounding Medicare, and it can get confusing knowing the difference between parts A, B, C, or D, and what Original Medicare is and so on! To try and make it as straight forward as possible, here’s how we approach it.
Medicare Part A covers short term hospital care. If you get sick and need to stay in a hospital for less than 90 days, Medicare Part A will help cover you. If you’ve paid your taxes for 10 years, odds are you qualify for free Medicare Part A.
Medicare Part B is just like a normal healthcare plan. Think about it as being similar to your Sharp, Kaiser, etc. It’s there to help you pay for doctor visits, tests, and things like that. Medicare Part B covers 80% of all covered medical services. It costs around $150 a month, but the rate varies based on your lifetime income.
By combining Medicare part A and B, you get what’s called “Original Medicare.” This is Medicare that’s fully run by the government and covers what’s listed above for a premium that’s around $150 a month. It can be deducted from Social Security.
Medicare Part C is also known as Medicare Advantage, which is kind of tricky. Medicare Part C is very similar to Original Medicare except it is managed by private companies instead of the government. There are all sorts of reason people prefer that, and all sorts of reasons people don’t. Medicare Part C is more customizable and is considered a “complete insurance package,” many Medicare Part C plans use a copay model and can even stack on top of Medicare Parts A and B. They also have networks, so pay close attention to that if you’re looking.
Medicare Part D covers prescription drugs. This is an add on for Original Medicare and is often included in Medicare part C plans. It costs between $10-40 a month and varies based on who ends up being your insurer. Medicare Part D is covered by Sharp Medicare Advantage! So if you get it, you don’t need to enroll in it seperately.
Medicare Supplemental Insurance is a hybrid between Original Medicare and a normal PPO plan. It basically provides additional coverage and pays into your Medicare part B coinsurance. These plans are rarer, but still important to know about.
So, is Sharp Medicare Advantage right for me?
This really depends. You’ll be spending more monthly on health insurance than you would with Original Medicare, but you get a really generous out-of-pocket maximum and much more affordable copayments than you would with Part B’s coinsurance. We think it’s a great plan, otherwise we wouldn’t offer it. But Medicare is complicated, so you really need to do what’s best for you.
Just remember that Original Medicare only covers 80% of health services, whereas Sharp Medicare Advantage has copayments for most of the common services. Additionally, it’s important to think about where you plan to live. Sharp is only available in San Diego County. If you live outside of San Diego county, you are not eligible for this plan.
How do I enroll?
Please contact SDPEBA by emailing support@SDPEBA.org or call 888-315-8027. If you are about to retire and you would like to enroll, give us a call for more details.
If you are already enrolled and want to change your PCP or have any issues, please call Sharp’s Medicare Team at (855) 562-8853.
How do I use the plan?
Once you enroll, you’ll select a primary care provider from either the Sharp Rees-Steely or the Sharp Community Group.
About Us
The San Diego Public Employee Benefit Association is a partnership of unions and associations designed to help reduce costs, improve benefits, and enhance support for San Diego’s public employees. We’re here to answer your questions and help make sure you get the most out of your benefits while also advocating for you directly to the provider to make sure you get the best experience possible.