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TRADITIONAL MEDICARE AND WHAT IT CONSISTS OF? WHEN AND HOW TO ENROLL?
6
Wednesday, October 2, 2024
Information from The Texas Tribune and The Associated Press
In recent months, South Texas has witnessed a significant drop in illegal border crossings, while cross-border commerce has seen a resurgence, particularly in key entry points like Laredo and McAllen. This shift marks a noticeable change along the border, which has long been a flashpoint for both immigration enforcement and economic activity.
Illegal crossings decrease sharply
The decline in illegal border crossings has been striking, with arrests for illegal entries down nearly 80% across the entire
southern border between December and July, including the Border Patrol’s Texas sectors. A combination of new U.S. asylum restrictions, more aggressive enforcement within Mexico, and the typical summer slowdown due to extreme heat has contributed to the reduced activity.
In McAllen, for instance, Border Patrol agents scanned fields near the Rio Grande for hours, but reported no migrant encounters. This is a stark contrast to just a few months ago when the area saw frequent large groups of migrants attempting to cross. Similarly, in Eagle Pass and other key areas along the border, the once-constant flow of people has diminished significantly.
The Rio Grande Valley, one of the busiest areas for Border Patrol operations, has www.english.elperiodicousa.com
experienced a similar drop in activity. The migrant presence that often overflowed into local shelters and community resources has subsided, easing the burden on cities like Brownsville, McAllen, and Mission.
Cross-border commerce on the rise
Even as migrant crossings have declined, commerce between the U.S. and Mexico has been on the upswing, especially at the Laredo port of entry, the busiest commercial crossing in the nation. Last year, nearly 3 million trucks crossed into the U.S. through Laredo, handling a wide range of goods from agricultural products to automotive parts.
The COVID-19 pandemic briefly slowed trade in 2020, but since then, the flow of goods has rebounded strongly. As the busiest port along the U.S.-Mexico border, Laredo handles more than double the value of goods processed at other major crossings, including El Paso and Nogales, Arizona.
Commercial traffic has remained steady in South Texas, even as law enforcement shifts its focus back to economic security. The region’s economic ties to Mexico, particularly in cities like Laredo, McAllen, and Brownsville, continue to support thousands of jobs and provide essential goods to both countries.
While illegal crossings have declined, the state of Texas has not slowed its border security efforts. Operation Lone Star, the state’s $11 billion border initiative, remains in full swing. In Eagle Pass and along other sections of the Rio Grande, razor wire, buoys, and increased law enforcement presence continue to deter crossings.
Governor Greg Abbott’s administration has bused thousands of migrants to cities like New York and Chicago as part of its strategy to manage the flow. In places like the Rio Grande Valley, this approach has been met with mixed reactions. Local communities,
many of whom have long been accustomed to the ebb and flow of migrant populations, remain concerned about the long-term implications of the state’s strict border policies. Shelters like Annunciation House in El Paso, which serve the Rio Grande Valley and other border regions, have noticed a marked decrease in migrant numbers. Ruben Garcia, who runs the shelter network, recently reported receiving only 25 migrants for placement, a sharp drop from the hundreds seen in previous months.
Despite the reduced flow of migrants, Texas’ legal battles continue. Local advocacy groups, including those in the RGV, are bracing for continued scrutiny as Attorney General Ken Paxton pushes forward with lawsuits against shelters and organizations that aid migrants.
While the reduction in illegal crossings may seem like a victory for border security, the situation remains fluid. Political leaders on both sides of the debate, including Vice President Kamala Harris and former President Donald Trump, continue to use the border as a talking point for their respective campaigns.
Locally, South Texas cities are caught in the crosshairs of both national policy changes and state-level initiatives. Many residents express concerns that the ongoing enforcement measures, while effective in reducing crossings, could harm the region’s delicate balance between security and economic prosperity. The local economy relies heavily on cross-border trade and tourism, and any prolonged disruptions could affect the livelihood of thousands.
As the situation evolves, cities in the Rio Grande Valley and beyond will continue to navigate the complexities of life on the border — balancing security, commerce, and humanitarian concerns in one of the most dynamic regions of the country.
BY ANDRES OPPENHEIMER
Mexico’s incoming president Claudia Sheinbaum is sending the wrong signals before taking office: She has scared U.S. investors by actively supporting a controversial judicial reform, added fuel to a pointless spat with Spain, and invited the dictators of Cuba and Venezuela to her Oct. 1 inauguration.
Sheinbaum, a left-of-center protégé of outgoing populist president Andres Manuel Lopez Obrador, can hardly afford to pick fights with Mexico’s business community, or with its top trade partners. Thanks to the outgoing president’s ineptitude, the country’s economic growth has been recently downgraded by Mexico’s central bank to a meager 1.5 % in 2024, and 1.2 % in 2025.
More importantly, Mexico is scheduled to start negotiations next year to update its free trade agreement with the United States and Canada, which comes up for a revision in 2026. More than 80% of Mexico’s exports go to the U.S. market.
If anything, Sheinbaum should have remained silent about Lopez Obrador’s populist judicial reform. The judicial overhaul will in effect allow the president to control the judicial branch, which has triggered fears among investors that they will have no legal protections against potential expropriations or unfair government measures.
But instead of remaining quiet about it, Sheinbaum has enthusiastically embraced the judicial reform, even after Moody’s credit risk agency and major banks such as Morgan Stanley warned it may scare away investments. U.S. ambassador to Mexico
Ken Salazar has said that the judicial reform “threatens the historic commercial relationship” between Mexico and the United States.
In an interview last week, Mexico’s Senate President Gerardo Fernandez Noroña, a firebrand leftist member of Sheinbaum’s ruling Morena party, told me that “investors have nothing to fear” about the judicial reform.
But the fact is that, regardless of what Mexican authorities say, investors lend much more credence to what credit risk agencies and financial media say. The Wall Street Journal reported before the judicial reform became law that U.S. multinationals could freeze $35 billion in planned investments in Mexico because of it.
Likewise, Sheinbaum’s invitations to foreign dictators to her inauguration raises questions about her priorities. While she invited the dictators of Cuba, Venezuela and Russia, she did not extend invitations to the king of Spain or the presidents of Ecuador and Peru.
Although Russia’s president Vladimir Putin — who has an international arrest warrant against him — has already said he won’t be able to attend, he will send a top official in his place. Cuba’s dictator Miguel Diaz-Canel is scheduled to accept the invite and receive the same red-carpet welcome as democratically-elected leaders. Venezuela’s ruler Nicolás Maduro has not yet confirmed his attendance, but may very well appear at the last moment.
Sheinbaum has not invited Spain’s King Felipe VI because he has not responded to a 2019 Lopez Obrador letter demanding that Spain ask “forgiveness” for crimes committed during the Spanish conquest of Mexico. The Spanish government responded that the king’s exclusion was “absolutely unacceptable,” and that it would not send any official delegation to the incoming president’s inauguration.
It makes little sense for Sheinbaum to exclude the Spanish king for crimes that took place 500 years ago, while at the same time giving a royal welcome to dictators who are committing major human rights abuses nowadays. And yet, Sheinbaum has celebrated the escalation of tensions with Spain as a major victory for Mexico, claiming on Sept. 25 that Spain’s refusal to ask forgiveness for its abuses during the Conquest is “an offense” to the Mexican people.
Just as inconsistent, if not more, is the fact that Sheinbaum has not invited the constitutionally elected presidents of Ecuador and Perú. Lopez Obrador has falsely claimed that they are not legitimate, and Sheinbaum has in effect bought that lie.
Amazingly, Sheinbaum’s inaugural guest list suggests that she considers the dictators of Cuba and Venezuela more legitimate than those of Ecuador and Peru. That’s absurd. As politically difficult as it may be for her, she should take distance from her predecessor, and focus on attracting investments and reducing poverty.
By Laura Butterbrodt
Here’s what the Texas Transportation Commission discussed and approved at its meeting on Sept. 26, 2024.
The Texas Transportation Commission awarded a total of $44.4 million in state and Federal Transit Administration program funds to 31 public transit agencies in Texas to support rural bus services. Of this funding, $18.5 million from the federal Bus and Bus Facilities Program is for fleets and $8.4 million is for facilities.
Additional state funding of $4.6 million will go toward fleets and $2.1 million will go toward facilities. Three rural transit districts will share $7.4 million for low-emission vehicle funding.
The Commission also awarded more than $800,000 in state and Federal Transit Administration Formula Grants for Rural Areas to Gulf Coast Transit District to support its rural and urbanized public transportation needs in Brazoria and Galveston counties.
Maritime
The Commission approved a Ship Channel Improvement Revolving Fund loan of up to $43 million over 30 years for the Brownsville Navigation District. The loan will assist in widening or deepening the Brazos Island Harbor Channel.
Commissioners also approved the Gulf Intracoastal Waterway Report, an annual evaluation that will be presented to the 89th Texas Legislature.
Commissioners voted to approve new rule amendments in the Texas Administrative Code, including:
Add roadside assistance programs to the state acknowledgement program. With this
change, people and organizations can donate to safety service patrols, including the HERO (Highway Emergency Response Operator) program. TxDOT can acknowledge these donations by displaying a name, logo or image on the back of the patrol trucks.
Enact a new variable speed limit program. This will allow TxDOT to temporarily lower the speed limit on some designated roadways by a maximum of 10 mph from the existing limit under certain conditions, including inclement weather, congestion or road construction. The program will begin with road segments tied to the TxDOT Intelligent Transportation System to ensure cameras can verify conditions, as well as log when and where speed reductions occur and return to normal conditions.
The Commission appointed members to the following advisory committees:
Aviation Bicycle and Pedestrian Border Trade Port Authority
Each of the committees help guide policy and provide recommendations for development and strategy of each specialty topic.
The Commission approved the following letting amounts for contracts:
$1.9 billion for 76 highway improvement projects.
$34 million for 25 routine maintenance projects.
$12.3 million for four building construction and rehabilitation projects.
Commissioners approved $34 million aviation grant funding for 13 projects at 12 Texas airports. The funding includes federal non-primary entitlement, federal apportionment, Infrastructure and Investment Jobs Act and state grants.
The Commission approved the Fiscal Year 2025 internal audit plan. This is an annual measure taken to ensure resources are adequately dedicated and managed.
UTRGV dent, succeeding
By Saira
Dr. graduate walks Massachusetts Medical A her third of Harvard’s Program. Day celebration UTRGV September Science Saavedra-Simmons
UTRGV School of Medicine former student, now at Harvard, shares how she is succeeding in medicine
By Saira Cabrera
Dr. Adriana Saavedra-Simmons, a 2022 graduate of the UTRGV School of Medicine, walks confidently down the pale hallways of Massachusetts General Hospital - Harvard Medical School, to visit with her patients. A Valley native, she is now completing her third year as a resident physician as part of Harvard’s Internal Medicine Residency Program. She matched on the annual Match Day celebration on March 18, 2022, on the UTRGV Edinburg Campus.
September is Women in Medicine and Science Month, and celebrates women like Saavedra-Simmons who are making strides
in a field once dominated by men. Today, though, more and more women like Saavedra-Simmons are donning the white coat, paving the way for future generations of skilled women to have a career in medicine.
“It is amazing to think that it has been 13 years since I first embarked on the pre-medical journey,” Saavedra-Simmons said. “I say this to highlight that success takes time. And that’s OK.”
From self-doubt, to navigating the challenges of medical school and the previously limited resources available in the Valley – a problem addressed by the UTRGV School of Medicine – Saavedra-Simmons said she is grateful for her journey and hopes to pave the way for other Valley students like herself.
“Medicine really is a marathon, not a sprint,” Saavedra-Simmons said. “My advice is to get surrounded by people who lift you up, mentors who offer practical advice on making it to the next step despite setbacks.”
A first-generation college graduate and the daughter of Mexican immigrants, she advises others like herself to have faith and stay positive.
“Imposter syndrome – the self-doubt that often plagues first-generation aspiring physicians – is ever-present,” she said. “Being intentional about practicing a growth mindset and reflecting on our achievements reminds us that we belong in medicine. Paying it forward, along with a strong faith system and mentoring others, all help thwart feelings of self-doubt.”
Saavedra-Simmons grew up in the Rio Grande Valley and understands well the challenges of being an immigrant.
Still, while the Valley too often has been an underserved region, she said, she has learned that difficulties can be overcome.
“While my program at Mass-Gen is rigorous,” she said, “it’s a program filled with the most brilliant and kind co-residents. I have grown so much as a physician and am grateful to train here.”
She is one of the many success stories the UTRGV School of Medicine has produced.
This year alone, more than half the UTRGV School of Medicine’s Class of 2028 students are women.
And in total, of the 220 medical students from the UTRGV School of Medicine, 121 are women.
“The UTRGV School of Medicine gave me opportunities to highlight my dedication to serving underserved communities, such as the one I come from,” Saavedra-Simmons said. “Even now, as I apply to endocrinology fellowships, I share the meaningful impact the UTRGV Student Run Clinic had on my growth as a physician.”
As a third-year medical resident, she supervises residents in the ICU, general medicine and cardiac units. She also serves as the code/rapid leader for destabilizing patients in all departments at Massachusetts General.
“It is a privilege to be part of patients’ lives in their darkest moments. I enjoy medicine because it combines pathophysiology with a patient’s story,” she said. “Each story is different, and internal medicine has equipped me to diagnose complex cases.”
Before leaving South Texas for the East Coast, she helped make sure other Valley students would not have to face some of the logistical challenges she had.
“While working full-time in the Valley, I had to travel two hours to take the MCAT (Medical College Admission Test), since there were limited spots in the Valley,” she said. “Later, when the chief academic officer of the Association of American Medical Colleges visited our institution, I advocated for increased testing sites in the Valley.”
Since then, eight testing sites have been added in Texas – including one in the Valley.
“I am proud to pay it forward to decrease barriers for underrepresented students like me,” she said. “I am grateful to God that with the help of mentors and tutors, I became strong academically and can continue on this path.”
As a soon-to-be fellow physician, Saavedra-Simmons has a solid vision of what she wants to do with her medical career.
“I am applying to an endocrinology fellowship. My goal is to return to the Valley to mitigate diabetes disparities through community health initiatives,” she said. “Given that the UT Health RGV Cancer and Surgery Center is opening soon, I am also interested in serving as a resource for immune checkpoint inhibitor endocrinopathies.”
Saavedra-Simmons said she is especially grateful for the support she has received along the way.
“We succeed together,” she said, “not alone.”
The 54-hole event will feature 36 holes on Monday and the final 18 holes on Tuesday. Play will start on each day with a shotgun start at 8:30 a.m. Westwood Golf Club plays 7,184 yards and is a par 72.
The Competition
There will be a 15-team field that will feature UTRGV, host Rice (2 teams), Abilene Christian, Houston, Houston Christian, Lamar, Louisiana-Monroe, Samford, Sam Houston, UT Arlington, Wichita State, LSU (Individuals), Oklahoma (Individuals), Oklahoma State (Individuals), Texas A&M (Individuals).
Starting Five
Arthit Kruaprayong
Juan Luis de Bethencourt Duque
Luis Limon
Taj Sutherland
Esteban Gonzalez
Eddie Lai (Playing as an individual)
Last Time Out
The Vaqueros opened the fall with a 14th place finish at the JT Poston Invitational. UTRGV posted rounds of 291, 295, and
288 for a three-round score of 874.
Junior Arthit Kruaprayong led the way as he finished tied for seventh with a threeround score of 209 after posting rounds of 71, 67, and 71. Junior Luis Limon tied for 46th with a three-round score of 220 after turning in rounds of 75, 73, and 72.
Senior Juan Luis de Bethencourt Duque finished tied for 55th with a threeround score of 221 with rounds of 74, 77, and 70. Redshirt senior Taj Sutherland finished tied for 73rd with a three-round score of 225 with rounds of 72, 78, and 75.
Sophomore Esteban Gonzalez finished tied for 82nd with a three-round score of 227 with rounds of 74, 78, and 75. Sophomore Eddie Lai finished tied for 70th as an individual with a three-round score of 224 after posting rounds of 68, 81, and 75.
Last Time at Bayou City Collegiate Classic
UTRGV did not compete in last year’s Bayou City Collegiate Classic.
Sam Houston won last year’s classic with a three-round score of 839 after posting rounds of 277, 281, and 281.
Sam Houston’s Bret Gray won the individual title with an 11-under 205 with rounds of 69, 66, and 70.
The University of Texas Rio Grande Valley (UTRGV) Department of Intercollegiate Athletics launched on Tuesday a comprehensive Name, Image and Likeness (NIL) platform — the Rally the Valley NIL Exchange — that provides the opportunity for student-athletes and registered third parties to directly connect for NIL partnerships and opportunities.
The Rally the Valley NIL Exchange, which can be found at GoUTRGV.com/ NIL, is a free service specifically created in partnership with Teamworks Influencer for UTRGV student-athletes to establish a connection with authorized companies, collectives, alumni, donors, and any other interested NIL entities. Through this new, streamlined platform, registered businesses and individuals may now immediately interact, negotiate, and complete NIL transactions with UTRGV student-athletes.
UTRGV student-athletes now have access to third parties that create opportunities such as autograph sessions, personal appearances, camps, clinics, private sports lessons, charitable work, and more.
“We’re excited to be able to provide easier access to NIL opportunities for our student-athletes,” UTRGV Vice President and Director of Athletics Chasse Conque said. “We are pleased that our partnership with Teamworks continues to grow in a meaningful way, including the use of Influencer to elevate our student-athletes’ brands.”
Teamworks Influencer is the national leader in athletic brand building and NIL. Its platforms are used by more than 3,500 collegiate and professional sports teams, with more than 100,000 active athlete users.
Once an agreement is reached, a customized reporting form compliant with Texas law and NCAA rules is created and forwarded to the UTRGV Athletics compliance office.
The Rally the Valley NIL Exchange incorporates a payment processing tool to pay student-athletes. The exchange also provides education on NIL issues, such as financial literacy and brand building, while assisting with market research and social media growth.
“We’re excited to partner with UTRGV on the launch of the Rally the Valley NIL Exchange,” said Sean Kelly, General Manager of Teamworks Influencer. “This custom NIL marketplace will open new doors for their student-athletes, empowering them to grow their personal brands and secure NIL deals on a larger scale.”
Teamworks Influencer, available on Teamworks’ Operating System for Sports™, is the leading athlete brand-building and NIL business management app for over 270 elite collegiate and professional sports organizations. The Influencer athlete app educates student-athletes, coaches, and staff for the NIL era in a safe and compliant environment, all powered by best-in-class content delivery for student-athletes to access and share content to their social media channels. The Influencer platform also includes the impactful Influencer Exchange. Schools can direct businesses, collectives, and fans seeking to find, communicate with, pay, and report NIL transactions with student-athletes in this school-customized NIL exchange. The Influencer Local Exchange maximizes the student-athlete wallet share while streamlining compliance and tax reporting responsibilities. To learn more about the Influencer Exchange, please visit teamworks.com/influencer.
Texas – The City of Pharr is excited to announce that registration is now open for the annual Pharr Salute to Veterans Parade and Fireworks Show. This community celebration will honor veterans and their service to our country.
The event will take place on Saturday, November 9, 2024, beginning at 5:30 PM in Downtown Pharr (200 S. Cage Blvd). The festivities will kick off with the parade at 5:30 PM, followed by Hub Market Days and live music at 7:00 PM, and the evening will conclude with a spectacular Fireworks Show at 8:00 PM.
Local businesses, organizations, and individuals are invited to join the parade by registering online. Register today to participate in this special tribute by filling out the 2024 Veterans Parade Registration Form. All entries are welcome, and early registration is encouraged. Join us for a memorable day of gratitude, community spirit, and entertainment as we honor the men and women who have bravely served our nation. Don’t forget to show your patriotism by wearing red, white, and blue! All media and the public are invited to attend.
La Plaza is excited to announce that the beauty retailer Miss A will join its dynamic lineup of retailers, and is also welcoming Candeeland, an immersive indoor play center set to open its second Texas location within McAllen’s top shopping destination. Additionally, La Plaza shoppers can now enjoy refreshing drinks and smoothies from Fresca Palapa, and Ben & Jerry’s premium ice cream.
Coming Soon:
Miss A: The ultimate beauty retailer where customers can have fun while not breaking the bank. Makeup lovers are invited to shop for the latest beauty trends and newest must-have beauty essentials at Miss A. Opening November 2024, located near Center Court.
Candeeland: a sweet place for kids to play, Candeeland offers an immersive indoor play center where the power of play is important. Families are invited to pack their sense of adventure and enjoy a day of sweet surprises and unforgettable memories. Opening November 2024, located near JCPenney
Now Open:
Fresca Palapa: Enjoy a variety of traditional and refreshing drinks from Mexico. Fresca Palapa offers classic natural-flavored fruit juices, smoothies, mangonadas, piña coladas, an array of colorful fruit cups, and more. Opened September 2024, located in the food court.
Ben & Jerry’s: Ben & Jerry’s produces various super-premium ice cream and ice cream novelties, using Vermont dairy products and high-quality, all-natural ingredients. With something for everyone, guests can scoop up all the flavors including fan favorites such as Half Baked, Cherry Garcia, Chocolate Chip Cookie Dough, Chocolate Fudge Brownie, and more. Opened August 2024, located next to Rocky Mountain Chocolate Factory.
Stay up to date on hours, promotions, and new stores by visiting the La Plaza website or following along on Instagram and Facebook.
Chrome In The Sand: Get Ready for a Festival Like No Other!
The coastal breeze, the roar of engines, and the glint of chrome under the Texas sun – it can only mean one thing. The Chrome in the Sand Festival is back! This October 18-19, 2024, automotive enthusiasts, thrill-seekers, and beach lovers will converge at the South Padre Island Convention Center for two days of heart-pounding excitement and high-octane entertainment. If custom cars, bikes, and trucks are your thing, this is your paradise. Chrome in the Sand is renowned for showcasing some of the most stunning automotive builds in the country. Whether you’re a collector, a builder, or simply a fan of everything with wheels, the festival promises an eye-popping display of chrome, paint, and power. From vintage classics to modern marvels, there’s something for everyone.
But that’s not all! As you admire the vehicles, enjoy live entertainment with performances that keep the energy levels high throughout the festival. Feel the rhythm of the beach and take in the electric atmosphere that only South Padre Island can provide.
In a unique twist, this year’s festival also features a world-class boxing event, blending the adrenaline of the automotive world with the intensity of live sports. Witness some of the top fighters square off in the ring for an unforgettable night of punches, power, and prestige.
Fans of the hit show Orange County Choppers are in for a treat, as Paul Teutul Sr. makes a special guest appearance. A legend in the world of custom motorcycles, Paul will be on hand to meet fans, sign autographs, and share his passion for bike building.
For those looking to take their experience to the next level, the festival offers exclusive VIP experiences. Gain access to premium areas, special events, and even the chance to meet the stars of the show. Don’t forget about the competitions! With categories for cars, bikes, and trucks, participants will have the chance to show off their rides and take home trophies, prizes, and bragging rights.
Chrome in the Sand is more than just a car show – it’s an event for the entire family. With beachside activities, food vendors, and entertainment for all ages, it’s a perfect weekend escape.
So, mark your calendars and get ready for an unforgettable weekend at the Chrome in the Sand Festival on October 18-19, 2024. Whether you’re coming for the cars, the boxing, the music, or the sun-soaked beachside fun, this is one event you won’t want to miss.
MARTA JIMÉNEZ
INDEPENDENT INSURANCE AGENT
5500 N. MCCOLL RD STE A OFF TELF 956-631-2202 CELL 956-467-6994
Medicare Supplement:
Medicare Supplement, also known as Medigap, is a secondary insurance, offered by private insurance companies, which is purchased to cover part or all the patient’s out-of-pocket costs, not covered by traditional Medicare, such as copayments, deductibles, coinsurance of 20%.
The Medicare supplement does not cover prescriptions at pharmacies and only coordinates benefits with traditional Medicare. When a person enrolls in Medicare supplement, this will be the secondary coverage and Medicare A and B the primary coverage.
In this choice, it is also recommended and ideal to acquire a Medicare Part D plan to cover prescriptions at pharmacies.
When we enroll in Medicare Supplement we are like pre-paying for medical services, we will pay a monthly premium or price and this will eliminate or reduce expenses in copayments, deductibles and coinsurance.
There are many types of Medicare supplements:
A, B, D, G, G1, K, L, M, N, C and F.
The most common are:
Medicare Supplement Plan G: Medicare supplement plan G covers the entire 20% that Medicare does not cover and the Medicare Part A deductible in the Hospital. The client will only be responsible for paying the Medicare Part B deductible, which at this time is 240.00 once a year.
After that, the client is 100% covered in doctors and hospitals nationwide, as long as the doctors and hospitals accept Medicare.
Medicare Supplement Plan N: This Medicare Supplement plan will cover the entire 20% that Medicare does not cover and the deductible in the hospital. The client pays a copayment of 20 to 50 dollars each time they receive services and the Medicare Part B deductible once a year, after that the plan covers the rest.
Prescription Plans or Medicare Part D.
Prescription Plans (Plan D) or (PDP)
are independent plans to cover medications prescribed by the Doctor, in pharmacies.
Medicare Part D Plans are offered by private insurance companies that have a contract with Medicare to offer these plans.
A Prescription Plan or Plan D will have a premium or monthly payment and other related expenses such as deductible, coinsurance and copayment, depending on the type of medication in question.
Each prescription plan will have a Formulary or list of Medications that are covered by that plan, so it is vitally important to review any coverage that is necessary, before selecting the plan.
Each year, the client will have the opportunity to review their plan during the annual AEP enrollment period, from October 15 to December 7. During this period, the client will be able to determine if it is still the best option for the following year or if they require or want to make changes for the following year.
Medicare Advantage or Medicare Part C Plans
Medicare Advantage or Medicare Part C plans are offered by private companies that have contracts with Medicare to offer these plans.
Medicare Advantage is a way to receive Medicare Part A and B benefits through private insurance companies. In this sense, it is a mandatory requirement to have Medicare A and B if you want to enroll in a Medicare Part C plan.
When the client enrolls in a Medicare Part C plan, this will be their primary health plan, until the contract is in effect.
Medicare Part C by law covers all benefits covered by Medicare, through the network of the chosen plan.
Medicare Advantage usually offers other additional services not covered by original Medicare, such as Vision, Dental, transportation, gym, among others.
Very often the Medicare Part C plan also includes a prescription plan for Medicare Part D. Each plan is different, and it is important to review the list of medications,
doctors, and any other benefits.
There are different types of Medicare Part C plans, among the most common we have the HMO and PPO plans.
Health maintenance organizations. This is a type of Medicare Part C that focuses on the coordination and management of the patient’s health, through their family doctor and focused on preventive medicine’s It usually limits coverage to doctors and hospitals that are in the plan’s network, also geographically limited.
The exception to the rule is medical emergencies. When a client has a medical emergency, they can go to the nearest hospital, nationwide.
Typically, HMO plans will have lower copayments and premiums and more additional benefits available to the client.
This type of Medicare Part C offers in-network and out-of-network coverage (usually at a higher cost) through a list of plans.
PPO plans offer a lot of freedom of choice to the client, where and when to receive their services, it does not require referrals to see specialists.
It is ideal for a client who wants to continue having control over when and where to receive medical services.
Each plan will have a Network or group of doctors and hospitals that will be covered by the plan. Each plan has its rules and regulations to follow.
Before enrolling in any plan, it is important to remember to review the client’s needs and preferences regarding doctors, hospitals, pharmacies and copayments for each service to have the best plan for those needs and preferences.
