Lyndon Thomas Insurance
THESE MALLS WERE MADE FORWALKING The Exercise Venue That Will Keep You Cool and Fit
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Thank you to Elaine N. for this month’s question: Please explain the difference between Medicare HMOs and PPOs and the pros and cons of both.
Both Parts A and B must be effective to purchase Medicare Supplement and Medicare Advantage plans.
Let’s start with Original Medicare, also known as “Fee for Service.” Original Medicare is administered directly by the federal government, and the Medicare card is used at any provider in the U.S. that contracts with Medicare. Providers bill Medicare directly and receive payment after services have been delivered and cover inpatient and outpatient medical expenses. A Medicare Supplement Policy may be teamed with Original Medicare. A Medicare Supplement Policy (a.k.a. “Medigap” policy) dovetails with Medicare and pays for all of what Medicare doesn’t pay (Supplement F) or pays for most of what Medicare doesn’t pay (Supplement Plans G and N). Supplements are “secondary” to Medicare and will pay only when Medicare first approves and pays its portion for services. Medigap policies are often referred to as PPOs. A PPO is a type of insurance policy that affords the member the ability to access providers without a referral or approval from a network. With Original Medicare and Supplements, “PPO-like” flexibility of provider access is enjoyed because any provider throughout the U.S. that contracts with Medicare is available, even though Medicare and Supplements are not PPO insurance. Medigap policies do not include the Part D Prescription Drug Program. Part D Prescription Drug Coverage When using Original Medicare with or without a Supplement, a prescription drug coverage is provided by purchasing a Part D Drug Plan from a private insurance company. Original Medicare, plus a Supplement, plus a Stand Alone Part D is what I refer to as the “a la carte health plan,” as the member carries three ID cards, each of which fulfills a specific role in one’s health coverage, affording the member a remarkable degree of flexibility in provider access, premium, and low out- of-pocket expense. Medicare Advantage Plans Under the terms of the Medicare Advantage program, insurance companies contract with and are regulated by Medicare to provide all the benefits and services covered under Part A and Part B. A Medicare beneficiary enrolls their Medicare into the healthplan they join, and Medicare pays before services are received via a payment each month for that calendar year. Most Advantage plans in California are HMOs and build in the Part D to provide prescription coverage and are known as MA-PDs. Providers receive payments via the healthplan
If you’re young at heart and looking to stay (or get) in shape this summer, consider taking a trip to the mall. No, not to pick up some hot new exercise product or dietary supplement, but to walk a few laps. Safe and convenient, “mall walking” has become one of the biggest trends in senior fitness. COOL IN THE SUMMER, WARM IN THE WINTER This time of year, heatstroke can be a real concern when exercising outside. But that doesn’t mean you have to be a homebody. Because malls are spacious and climate-controlled, they make great year-round walking venues, especially when summer temperatures spike. You don’t even need to put on sunscreen! REST STOPS ABOUND While the average American shopping center isn’t as scenic as the Appalachian Trail, they are far more convenient. Replete with bathrooms, cool drinking water, and plenty of benches, the mall lets you focus on exercising and removes all of the “what ifs” that come with aging. Most malls are also outfitted with EMT kits in the event of a medical emergency. SQUEEZE IN SOME SHOPPING It is still a mall, after all. Why not check a few items off your shopping list or reward yourself with a new pair of sneakers? Getting things done as you exercise makes the experience that much more rewarding. Just remember not to overdo it. Carrying too many shopping bags can place undue stress on your back — and your wallet. YOU WON’T BE ALONE Today, malls are the second-most popular places to walk in America, after neighborhoods. Mall walking has become so big that many communities and senior living centers have put together official groups to stride together. Your local mall may already open early to accommodate walkers. So if you’re looking to make friends in an active, fun-loving community, do some research. Chances are there’s a mall- walking club near you!
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