I Have Medicare or Medi-Cal
What do I need to do during Open Enrollment if I am on a Medicare Plan?
Medicare is not part of the Covered California Health Insurance Exchange
and therefore, your Medicare benefits will not be affected by the Affordable
Care Act. You are expected to begin Medicare on the first day of the month
that you turn age 65, which may fall outside of the typical Open Enrollment
period (each year during the fall).
You should receive your Medicare card in the mail 3 months before you
turn age 65. If you did not receive your card, it’s important for
you to call the Social Security Office at (800) 772-1213 or visit
http://www.socialsecurity.gov/retirement.
Hoag offers community education classes to assist with Medicare enrollment
and finding the plan that best fits your needs.
Individual Senior Medicare Advantage Plans
-
AARP Medicare Complete Secure Horizons Plan 2 (HMO)
by UnitedHealthcare
- Anthem Medicare Preferred Standard (PPO)
- Blue Shield 65 Plus (HMO)
- Blue Shield 65 Plus Choice (HMO)
- OneCare (HMO SNP)
- SCAN Classic (HMO), SCAN Balance (HMO SNP), SCAN Heart First (HMO SNP),
SCAN Plus (HMO)
Other Senior Programs
- Original Medicare Parts A & B
- Most Medicare Supplement Insurance (MediGap) plans
- Many Employer Group plans (Call the phone number on the back of your insurance
I.D. card to verify if Hoag is your network hospital.)
Types of Medicare Coverage Choices
- Original Medicare & Medicare Supplement Insurance (Medigap Policies)
- Medicare Advantage Plans (HMO’s or PPO’s)*
- Medicare Part D (Prescription Drug Coverage)**
*Must have Medicare Part A and Part B to enroll in the above plans.
**Must have Medicare Part A and/or Part B.
The Annual election period for Medicare Advantage and Part D “Stand-Alone”
prescription drug plans is October 15 – December 7
th. All beneficiaries can join, switch, or drop Medicare Advantage and Part
D prescription drug plans. Your new enrollment selections will take effect
on January 1
st.
Annual Election Period: October 15 – December 7th
Medicare Advantage Disenrollment
You may leave your Medicare Advantage Plan and switch to Original Medicare
from January 1 – February 14
th . You may enroll in a “stand-alone” Part D Drug Plan and apply
for a Medigap Policy, subject to medical underwriting during this time.
You are not allowed to switch to a different Advantage Plan until the
next annual enrollment period (October 15
th – December 7
th )
Medicare Advantage Disenrollment Period: January 1 – February 14th
If you currently access your Medicare health insurance through your employer please
click here.
What is Medicare?
Medicare began on July 1, 1966. It currently covers over 50 million people
ages 65 years or older or those individuals under age 65 currently qualifying
for Medicare Disability and all ages with end-stage renal disease.
Medicare Part A (Hospital Insurance) is for inpatient care in a hospital,
skilled nursing facility (not custodial or long-term care), hospice, and
some medically necessary home health care.
Most seniors don’t pay a premium for Medicare Part A because they,
or a spouse, already paid for it through payroll taxes while working.
Medicare Part B (Medical Insurance) is for medically necessary doctor services,
outpatient care, durable medical equipment, some home health care and
many preventative services.
Most seniors pay the standard monthly premium amount ($104.90) for Medicare
Part B. The premium amount is deducted from your social security check.
Medigap Supplement Insurance Policies are sold by private insurance companies
or brokers. Seniors typically look for programs such as this to help fill
the gaps that Original Medicare Parts A & B don’t cover such
as deductibles and co-payments. All policies have standardized coverage,
which means coverage doesn’t differ between companies; only the
premium amount you pay may be different.
Medicare Part C [Medicare Advantage (MA)]
Medicare Part C, more commonly known as Medicare Advantage (MA), is not
part of the Original Medicare (Part A and Part B). Medicare Advantage
Plans are offered by private companies approved by Medicare. Medicare
Advantage health plans (such as HMOs and PPOs) are legally required to
offer the same benefits as Original Medicare, but can include additional
coverage as well. Most Medicare Advantage Plans include Part D drug coverage.
Costs and coverage details can vary depending on the insurance company,
some Advantage plans charge a monthly premium.
Advantage plans may offer extra benefits like dental, vision and hearing.
Plans have a yearly cap and annual out-of-pocket maximum spending limits.
Medicare pays a fixed amount every month to the plan for your care. Medicare
Advantage plans are subject to change every year. So, it’s important
to review these plans in detail during your annual open enrollment period
to ensure coverage options have not changed.
Medicare Part D (Prescription Drug Coverage)
Medicare offers Part D prescription drug coverage to everyone that has
Medicare Part A and/or Part B. Part D plans (PDP’s) are sold by
various companies approved by Medicare. You will be responsible to pay
a monthly premium for your plan. Those costs and lists of specific drugs
covered will vary by plan.
(Source: 2013 Choosing a Medigap Policy, Medicare & You 2014, Medicare.gov
"special circumstances" )
The Medicaid program for low income individuals and families is known as
Medi-Cal in the state of California. Hoag participates in Medi-Cal, which
offers medical services for children and adults with limited resources.
Eligibility requirements for Medi-Cal are currently expanding. To check
eligibility or for a list of participating physicians please go to
www.dhcs.ca.gov or call 800-541-5555.