Medicare Minded
Posted in Eye Blog, Mount Vernon, Sedro-Woolley, Stanwood, Whidbey
Clarity and insight on Medicare and Medicare Advantage options for 2025
By Jodi Hulst, Director of RCM
Big decisions for 2025 are right around the corner. Open enrollment for most Medicare enrollees begins on October 15 and runs until December 7.
Cascadia Eye does not make insurance recommendations; each situation is too unique and there are many factors involved in choosing an insurance plan. We do, however, have some helpful information to share!
What will I pay?
Traditional Medicare coverage is the same for all enrollees. There is a monthly premium, a yearly deductible (for 2024 that was $240), and then Medicare pays at 80% of the allowed charge. Enrollees will be responsible for the remaining 20% or may purchase a supplemental plan to cover that portion.
What is the difference between Medicare and Medicare Advantage?
Medicare enrollees have the option of traditional Medicare or a Medicare Advantage plan offered by a commercial insurance carrier (such as Kaiser or United Healthcare).
Medicare Advantage will “replace” your traditional Medicare coverage. These plans may offer additional coverages that traditional Medicare does not, such as a routine eye exam and an annual allowance for glasses or contact lenses.* Cost and coverage can differ widely depending on the carrier and plan you choose. It is also important to look at the type of plan. PPO plans usually allow more flexibility to see providers as you choose, HMO plans will often require a referral from your primary care provider (PCP) to see any other doctor. This is important to know to ensure that services beyond those from your PCP will be covered by the plan.
*Many Medicare Advantage plans carve out the vision benefits to a third party vision carrier, such as EyeMed or VSP. These benefits are for a routine eye exam (exam done in the absence of any eye complaints or chronic medical conditions) and glasses or contact lenses. It is important to know this as not all eyecare practices participate with all vision plans. Most patients have conditions that qualify them to have a medical eye exam, in which case claims would be submitted directly to the medical plan.
Some questions to ask if you are looking at a Medicare Advantage policy:
- What is the monthly premium?
- Is there an annual deductible?
- What is the copay for office visits?
- Will I need a referral to see a doctor other than my PCP?
- Is there a third party payer for vision or other services?
What plans does Cascadia Eye accept?
We take many phone calls this time of year with questions about the plans that Cascadia Eye accepts. We are a contracted provider with the following payers:
- Aetna
- Community Health Plan
- Humana
- Kaiser
- United Healthcare
If you have a PPO plan with any other Medicare Advantage product, you can still be seen at our office. You will need to know your out-of-network benefits (check your plan documents or call your plan). We will submit a claim for you! If you have an HMO plan, you will need to see a contracted provider. Most plans offer an extensive list online of contracted doctors.
Some helpful links:
Costs of Medicare (2024 Information): https://www.medicare.gov/basics/costs/medicare-costs
Information about Medicare Advantage: https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options
Medicare Advantage Plans 2025 by Zip Code: https://www.medicare.gov/plan-compare/#/?year=2025&lang=en
Statewide Health Insurance Benefits Advisors (SHIBA): https://www.insurance.wa.gov/about-shiba-services
Director of RCM
Contact Cascadia Eye
If you would like to learn more, or if you would like to schedule an appointment or consultation with our talented doctors at Cascadia Eye, please contact us today. You may also pre-shop for glasses at our online pre-shopping page any time. Our entire team is committed to protecting and improving your vision and the health of your eyes. We are happy to answer any questions you might have!
In addition, join us on Facebook, Instagram or YouTube to ask your questions about eyes, exams, and our practice. We’d love to hear from you – and there might be a blog to address your questions in the future.
