Call California's Health Insurance Counseling and Advocacy Program (HICAP) for counseling. HICAP is a network of community-based programs that provide free education, counseling and aid about Medicare and related health and prescription drug insurance coverage (call 800-434-0222). Additional resources include: Medicare, the California Department of Insurance and your local Area Agency on Aging. (See Resources.) If you have questions or complaints about your HMO, contact the state Department of Managed Health Care HMO Help Center at 888-466-2219 (www.hmohelp.ca.gov).
You may be entitled, by law, to continued coverage under your employer's group health insurance plan for a short period of time. Some employers actually maintain health insurance for their retired employees. As a senior you have other options. Medicare, Medigap policies, health maintenance organizations (HMOs), Medi-Cal or veterans' benefits may help cover your medical expenses.
On March 23, 2010, the federal Patient Protection and Affordable Care Act became law. It requires most people to have health insurance by 2014 and helps defray costs for those with moderate or low income. The act guarantees an annual wellness visit for people in traditional Medicare programs and requires preventive care such as flu shots, mammograms and cancer screenings. For information call the state's Health Insurance Counseling and Advocacy Program at 800-434-0222 or go to www.medicare.gov.
Medicare is a federal health insurance program that covers Social Security recipients who are at least 65 years old or who are younger, but have disabilities such as kidney failure. Income level and assets have no bearing on an individual's eligibility for coverage.
Generally, Medicare participants may choose between the Original Medicare Plan, a Medicare Advantage Plan (sometimes called Part C-- an HMO or PPO), a special needs plan, a private fee-for-service plan and, in some instances, other Medicare health plans that are only available in certain parts of the country. The participant pays the deductibles, co-payments and, in some cases, a monthly premium. Medicare then pays the rest of the tab for covered services.
The program has three components. Part A--referred to as hospital insurance--covers inpatient hospital care, some skilled nursing and home health care and hospice care. Part B--which in 2013 had a $104.90 to $335.70 monthly premium--helps pay for additional services. (It may cover physical and occupational therapy, for example, and some medically necessary home health care.) Part D launched in 2006 to provide prescription drug coverage. If you have very little income or currently receive certain other government benefits, you may qualify for greater help with your prescription drug bills.
Under Part D, all Medicare beneficiaries now qualify for prescription drug coverage. As a beneficiary, you can choose from a variety of Medicare-approved prescription drug plans. Keep in mind that these private insurance plans vary--in their premiums, deductibles, co-payments and lists of covered prescription drugs. You might choose to enroll in a Medicare Advantage Plan that covers physician and hospital care as well as prescription drugs. Before enrolling in any plan, make sure it meets your particular needs.
You may not need to enroll at all. You may already have a Medicare-approved prescription drug plan through Veterans Affairs or your employer, former employer, union or existing Medicare Advantage Plan. (If you are uncertain, contact your benefits advisor for guidance.) For more personalized assistance, go to Medicare's website, contact a Medicare representative or seek assistance from a HICAP counselor (see Resources).
It is supplemental health insurance that can help pay some of the expenses that are not covered by Original Medicare. For example, it may cover co-payments or some additional costs for a prolonged stay in a skilled nursing facility. Medigap does not, however, offer prescription drug coverage. Medicare handles such coverage. If you have a Medicare Advantage plan, you do not need Medigap. Under the new Affordable Care Act, you do not have to purchase a Medigap policy.
It is important to carefully consider your particular situation in deciding whether this supplemental insurance is worth the extra expense. Seek out the advice of a HICAP counselor or request a copy of Medicare's publication, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.
Unlike Medicare, Medi-Cal is a health insurance program based on need. It pays for the health care of seniors who are at least 65 and who have very limited resources and income. (If you receive Supplemental Security Income, you automatically qualify for Medi-Cal benefits.) But even if you do not meet the strict financial need requirements, you could still qualify for Medi-Cal benefits if you are at least 65, blind or disabled, and have very little money or property. In such a case, however, you might have to pay a portion of your medical expenses yourself as a "share of the cost." Medi-Cal covers doctor visits, lab tests, prescription drugs and long-term care. For more information on Medi-Cal eligibility and benefits, call your local Area Agency on Aging or your county social services agency. For information, contact the Department of Managed Health Care at 800-430-4263.
Probably. You may be eligible for health care services at more than 50 medical centers and clinics throughout the state. Depending on your household income and net worth, you may pay just $15 to see a primary care doctor and $50 to see a specialist. Your medicine could cost no more than $8 per prescription and you may be entitled to dental care. For information, call the U.S. Department of Veterans Affairs (see Resources) or the California Office of Patient Advocates at 800-430-4263.
It depends on your health, resources and arrangements for future care. There may come a time when you need daily or round-the-clock help with bathing, dressing and preparing meals. Such care can create serious financial strain on you and your loved ones. Medicare covers nursing facility and home health care but only if it is skilled care, medically necessary and for a limited period of time. But long-term care insurance covers custodial care. It may cover home health care, adult day care, nursing home care, the cost of an assisted living facility and respite care.
Before investing in this type of policy, consider your circumstances and seek free counseling from HICAP. Ask about the California Partnership for Long-Term Care insurance designed for low and middle-income Californians. To locate a local HICAP counselor, call the California Department of Aging. (See Resources.)
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