* Some Medicare beneficiaries who don't also sign on for a Medicare Advantage plan or a Medigap plan receive additional coverage from union or pension plans.
* Some Medicare beneficiaries who don't also sign on for a Medicare Advantage plan or a Medigap plan receive additional coverage from union or pension plans.
Patrick Weisgerber, a Medicare Advantage representative at Providence Health Plans, has comforting words for anyone feeling overwhelmed by the confounding choices, obscure language and downright mystifying regulations surrounding the nation’s health care plan for elders. 

First, he says, you’re not the only one who is bewildered. “I’ve had judges and PhDs say they don’t understand,” he says. 

Second, there’s help. A program called Senior Health Insurance Benefits Assistance brings human volunteers to help, free for anyone needing it. Medicare’s own publications and information from AARP also shed light. 

Beyond that, there may be an easier way. Genevieve Williams, a member of Ascension Parish who is active with the Archdiocesan Council of Catholic Women, was insured, along with her husband, through Kaiser Permanente before they retired. She’s still with that system. “They asked and I said yes,” she says of her move to Medicare Advantage.

Already familiar with Kaiser, Williams kept her doctors. The process was nearly seamless. She can feel good about her choice: Kaiser’s and Providence Health’s Medicare Advantage plans are the highest rated for value and coverage in Oregon, according to U.S. News & World Report. 

The many Oregonians covered through Providence Health easily could do the same. 

Because Williams chose to go with Medicare Advantage, she didn’t need to study up quite as much on the ins and outs of Medicare — although she knows enough about it to explain that her Kaiser Advantage plan replaces Part A (hospital insurance) and Part B (medical insurance) and even Part D (prescription drug coverage).

Medicare Advantage plans, sometimes known as Medicare Part C plans, are offered by private health care companies. They cover the same services as original Medicare, plus other services as well in some cases. 

Of the 835,111 Oregonians on Medicare as of September 2018, 43 percent of them have chosen Medicare Advantage — putting the state along with Minnesota, Hawaii and Florida for the highest percentage choosing Part C rather than traditional Medicare. 

Weisgerber notes that some 60-somethings may be confused about the fact that they must sign up for Medicare and make some of their choices for future health care when they turn 65. Some people think it happens automatically, he says, which it doesn’t. (There are exceptions to this, just as there are exceptions to everything with Medicare. If you’re actively working for a large company you don’t need to sign up for Medicare at 65, according to AARP.)

The biggest choice for most people on that birthday is whether to go with traditional Medicare, plus additional coverage from supplemental insurance, called Medigap, or to go with a Medicare Advantage plan.

Medigap plans are typically offered by large health care insurance companies like United Health.

This may be a one-direction choice, because there’s a brief window of opportunity to get on a Medigap policy without being penalized for pre-existing conditions. After that, people can be denied extra coverage based on health status, says Weisgerber. 

In contrast, there is an enrollment period every autumn to sign up for a Medicare Advantage plan, and people easily can change their minds about a plan if they decide another arrangement would work better.

When deciding between Medigap or Medicare Advantage, people should consider their potential out-of-pocket costs, Weisgerber urges. Traditional Medicare alone doesn’t cap those costs, but out-of-pocket costs are capped with Medicare Advantage and Medigap. That is the point.

Williams took that into consideration after she no longer received dental care from Kaiser. She needed to choose a supplemental dental plan and she also had to learn how to sign up for dental assistance, which she received for 2017, a crucial year for her needs. 

These days she pays the dental premium. “I don’t feel misused,” she says. “It’s just that it’s not free.”

While going with her longtime provider worked for Williams, that won’t be the path for everyone. In general, Weisgerber urges people do their homework and not make assumptions. 

“Start four to five months before you turn 65,” he says. “Read the Centers for Medicare Handbook, attend the free information meetings. Don’t wait until the day before you turn 65.”