California Medicare Advantage Options  -  Will Alignment Advantage plans work with PAMF?

Alignment Health and Sutter Palo Alto Medical Foundation

 

We get the calls almost daily.

 

"How can I get the Palo Alto Medicare Foundation with a Medicare advantage plan?"

Good news there...even for the highly coveted Pal Alto Medical Foundation.

There are a few different Advantage plans we can use but one is literally designed to work well in this network.

Sutter's right in the name!

 

The Alignment Health Plan Sutter Advantage (Medicare Advantage HMO) plan

Let's look more closely at this relationship and plan for people who need PAMF access.

Our credentials first:

 

We have some pretty good news.

We'll cover these topics:

• Quick intro to Alignment Advantage plans
• The Alignment Health Plan Sutter Advantage (Medicare Advantage HMO) plan
• How to quote and apply for the The Alignment Health Plan Sutter Advantage (Medicare Advantage HMO) plan

Big review on the Alignment Sutter plan.

 

Let's get started for Palo Alto Medical Foundation specifically.  First...who is Alignment?

Quick intro to Alignment Advantage plans

The name Alignment may be new to many people but not for long.

They are quickly eating up the Medicare Advantage market in the most competitive state to do so:

 

 

Those are heavy hitters with decades of experience. So what gives?

Alignment has just done everything right in the Advantage space and it shows.

We have a whole review of Alignment Medicare Advantage plans but luckily, you don't have to rely on our interactions with them.

The Star Rating is a way to see how actual, existing members view their plan and carrier and it's a total deal breaker for Advantage plans if they don't measure up.

On a scale of 5 with 3 being marginal and 4 being pretty fantastic, this is where Alignment shines.

4 Stars for most of the Alignment Health Sutter Advantage plans in California.

In the areas where this competes, 4 stars is generally right up near the top.

That's a very solid endorsement...not from us or the carrier but from 1000's of actual members on the every-day interactions with Alignment for PAMF.

This figures into our Triple Threat strategy for comparing Advantage plans:

 

 

Okay...that's one component down. What about the actual plan design?

The Alignment Health Plan Sutter Advantage (Medicare Advantage HMO) plan

Let's look at the basics of the Sutter Advantage plan and see how it stacks up.

 

 

 

First, the plan has a zero deductible. This means you don't have to pay a certain amount before getting help with medical expenses.

The monthly premium is $48/month. This compares with a G medicare supplement of around $150ish depending on age (and zip code).

You can always quote the medicare supplements here.

That's the whole Advantage versus Medicare supplement question to address first since we can use Medicare supplements with PAMF as well.

It's a question of cost (monthly) and when you get sick or hurt. Happy to compare these options for you at no cost for our assistance.

Basically, it's about $100/month difference (plus the Part D for medication since the Alignment plan for Sutter covers RX).

So...roughly $1200-1500 premium difference per year as a rough estimate.

 

Now what if we have really big health care expenses?

That's where the max out of pocket comes into play.

With the Alignment plan that works with PAMF, it's $3800/year.

That means that we pay copays and smaller amounts until we hit the $3800 cap for really high cost years.

That's the trade off with Advantage plans!

We'll pay less monthly but potentially pay more if our costs really explode higher in a given year.

Interestingly, this max out of pocket is really driven by area. In LA county, it's not unheard of to see maxes of around $800/year or less.

In the Bay Area where PAMF is, the maxes tend to be around 3-4K/year (and up from there actually).

That puts Alignment's Health Sutter plan with PAMF coverage right in the sweet spot for maxes in this area.

Here are some top level benefits (make sure to run your quote below for full and updated detail):

 

 

 

We're happy to send over the full benefit detail tailored with a personalized quote. Just email us at help@calhealth.net

Or...you can run your quote directly here.

 

How to quote and apply for the The Alignment Health Plan Sutter Advantage (Medicare Advantage HMO) plan for PAMF

This is easy.

You can instantly quote the Alignment Health Plan for Sutter with access to PAMF here:

 

A few quick notes.

Make sure to enter your doctor, RX/dosage, and pharmacy information in the Preference Box:

 

 

If the Alignment Plan for Sutter doesn't pop up, you may be outside the coverage region based on zip code. We can check this for you if it doesn't seem to match.

With all Advantage plans, there's a certain radius from where we live in order to qualify.

Otherwise, we may have to look at a Medicare supplement which allows you to see any provider that accepts medicare in the US!

If you're in the coverage region for PAMF though, you can quote the Alignment Sutter plan alongside other carriers/plans side by side via this quote:

 

Reach out with any questions and make sure to add your medications so that the quoting tool will show you the best values.

Also, sort the quote by "total estimated cost" which will take into account your medications specifically!

 

Happy Hunting with PAMF in sight!  Reach out with with any questions at help@calhealth.net or book a time to chat: https://calendly.com/dennis-jnw