Great news about lower premiums for Medicare: please read before making decisions: click here

 

Things to Consider When Shopping for Medicare Coverage

• There are two main ways to get your Medicare coverage — Original Medicare and Medicare Advantage (Medicare-approved plans from private companies). There are differences between the two that are important to understand when choosing your coverage.

• If you are selecting a Medicare Advantage plan, check with your health care providers to confirm they are in a plan’s network.  (We are not in-network for United Healthcare plans, AARP primary insurance, nor for HealthNet.)

• If you are selecting a Medicare prescription drug plan, check if your prescriptions are included on a plan’s formulary.

• Remember that a low monthly premium may not always be the best overall value to meet your specific needs.

• Review a plan’s estimated total costs to you, including deductible and other out-of-pocket costs.

• If you take insulin, there is a new out-of-pocket cap on a month’s supply of each insulin product when covered by a prescription drug plan or under Original Medicare. Talk to someone for help comparing plans by calling 1-800-MEDICARE.

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The new Oregon Basic Health Plan will help insure low-income residents not eligible for Medicaid after the federal public health emergency ends.  click here 

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Para garantizar que los habitantes de Oregón tengan acceso continuo a la atención médica, el estado planea establecer un Plan de salud básico para aquellos que perderán la cobertura del Plan de salud de Oregón.     click here

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Be sure to check if  we will accept your insurance plan. YOU must call your insurance company and ask them.  Find out how much you will have to pay to see your rheumatologist (your co-pay).

    

We do not accept the plans listed below, if a primary insurance plan.

    (If you do not recognize these plans, you probably do not have one of these plans.)

1. No HealthNet Ruby plans. We are out of network. We cannot see you.

2. No Health Net Medicare Complement (HMO) plan. We cannot see you.

3. No Primary Insurance UnitedHealthcare Commercial or Medicare. We are Out of Network Jan 1, 2023 will not accept primary plans from United Healthcare.  Check on your insurance card if your plan is managed by United Healthcare.  

4. No AARP Medicare Advantage Plans (if it is your Primary Insurance).

5. No UMR plans, if you have a plan that states you have no out-of-network benefit.

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We will accept the Medicare Supplement plan/secondary insurance offered by AARP or UHC.

We will accept the plans listed below this notification. (Scroll way down.)

Your insurance choices will affect your treatment options. 

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• Investigate your insurance choices carefully.

• Speak with the insurance company to verify if your physicians are 'in network'.

• In order to be treated in our clinic, you may need a formal 'referral' from your primary care provider for many plans we accept. Please check with your insurance plan! 

• Call your insurance company to verify approved treatments and coinsurance for your plan.

• If you change insurance plans, you must inform us immediately as this could change treatments allowed by your new insurance, copays, and even if we are out of network.

 Health Insurance Basics: click here

 Common Insurance Mistakes: click here

 What does primary insurance mean? click here

Veterans' Insurance plans, Kaiser Permanente Plans are accepted with a PCP referral and authorizations. Please help us by being sure you have a referral/authorization in place.

 

Keep asking your insurance company questions!

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Note on changing your Medicare Plans:  

If you are switching back to Traditional Medicare FROM a Medicare Advantage Plan, you will likely NOT be able to get your Medigap (Medicare Supplement) plan back, because you will have to go through underwriting (which means the plan will be very expensive, or you may not qualify for coverage at all). Beneficiaries are exempt from underwriting for Medigap supplement plans ONLY during their 1st 6 months of Medicare eligibility (and not at all if you initially choose a Medicare Advantage plan, because you can't have a supplement when you also have a Medicare Advantage plan).

This is what we call "Medicare Advantage's Dirty Little Secret". Most people, even those in healthcare, don't know these rules. PLEASE avoid a COSTLY mistake.

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