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Steps for Researching Medicare Options

The earliest date you can become eligible for the new Prescription Drug Plan is January 1, 2006 provided you enroll in a 2006 Medicare Health Plan Option by December 31, 2005. If you enroll in a 2006 Medicare Health Plan after December 31, 2005, you will not be eligible for a new Prescription Drug Plan until the first of the month following your health plan enrollment. The enrollment period to be eligible for a new Prescription Drug Plan without penalty is November 15, 2005 through May 15, 2006.

There are many resources available to help determine which 2006 Medicare Health Plan Option best fits your needs. Santa Cruz Medical Foundation (SCMF) Physicians and staff are not experts on the details of the many Medicare 2006 Health Plan Options. We recommend that you consult a trained expert in Medicare 2006 Health Plan Options who can help you make an informed decision.

Step 1: Learn which Medicare Health Plan Options are available to you in Santa Cruz County
For example:

Medicare Advantage Plans in Santa Cruz County for 2006 (covers Parts A & B & the New Part D – Prescription Drug Plan) are:

Secure Horizons Classic HMO Plan at (800) 698-7505
Type: Medicare HMO where SCMF Doctors do participate.

Freedom Blue Plan Options I & II at (800) 765-2585
Type: Medicare Regional PPO where SCMF Doctors do participate.

Secure Horizons Direct (SHD) Plans
Type: PFFS. SCMF Doctors do not participate in SHD Plans (e.g. SHD has no access to SCMF Doctors)

Medicare Prescription Drug Plans

“Stand Alone” Drug Plan Options If you want prescription drug coverage and decide to re-enroll in the Original Medicare Part A & B Plan or in a new PFFS Plan, (both of these plans do not include a Drug benefit), you will have to select a stand alone Part D Prescription Drug Plan. Over 40 different Medicare Prescription Drug stand alone Plan Options are marketed in Santa Cruz.

Drug Plans Already Bundled inside Medicare Advantage Plan Options
If you select the Secure Horizons HMO Option or the Freedom Blue PPO Option, you will get the Drug Plan option automatically. There is no need to select a stand alone Prescription Drug Plan.

Step 2: Confirm that your desired Physicians and Hospitals are listed in the Medicare Plan’s Network Provider Directories. This is available for your review and is typically on each Plan’s web site.

Step 3: Check if your prescription drugs and medications are listed on the Plan’s Drug Formulary list. Check carefully, as your Prescriptions may also be listed in their Formulary in the generic form.

Step 4: Compare Plan benefits coverage. Differences in what’s covered vary widely among Plan Options.

Step 5: Compare all your out-of-pocket costs to benefit coverage levels. This includes items such as: Plan’s monthly premiums, service & drug co-payments, coinsurances and deductibles.

Step 6: Call the Plans that you are most interested in directly. Ask questions. Assess each Plan’s level and quality of customer service, information provided, questions answered and friendliness of service.

Step 7: Get as much assistance as you can before deciding on a Medicare Health Plan Option for 2006. We recommend that you consult friends, family, experts & attend community meetings to learn more.

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