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 7^th

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 14^th

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" )

Medi-Cal:

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.