As a senior, you have many options to choose from for your health coverage. This website assists in  giving you information on senior health related information. The various senior health coverage options listed on this website describe some of their differences. How much does Medi-Cal cost?

You should consider your personal needs and finances before making any choice.

What Is Medicare?
It’s a federal government program that provides health insurance to people age 65 and older, certain disabled people under age 65, people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). The program is administered by the Centers for Medicare and Medicaid Services (CMS).

Original Medicare: Part A and Part B

  • Part A helps pay for inpatient hospital, skilled nursing facility, limited home health and hospice care.
  • Part B helps pay for doctor’s services and outpatient hospital services. It also covers diagnostic tests, ambulance transport, and preventive care including mammography and Pap tests and durable medical equipment and supplies.

Medicare Part C: Medicare Advantage Plans

  • Medicare Advantage (MA) Plans are run by private companies like Blue Shield. Basically, companies like Blue Shield contract with Medicare to provide the same basic benefits as Original Medicare plus more for Medicare beneficiaries. In return, these plans provide all of your Part A and Part B benefits and often provide additional benefits such as vision, hearing, dental, and health and wellness programs.
  • Based on the additional benefits they provide, MA plans can charge different co-payments, coinsurance and deductibles for their services and generally you will need to see those doctors who belong to the plan.

Medicare Part D: Prescription Drug Plans

  • Beneficiaries who do not have Medicare Part D coverage through some other source, like an employer plan, can get help with prescription drug costs through private companies that have the Centers for Medicare and Medicaid Services (CMS) approval to offer a Prescription Drug Plan.
  • Medicare Advantage-Prescription Drug plans (MA-PD) are plans that include prescription drug coverage. Prescription Drug Plans (PDP) are plans that offer stand-alone prescription drug benefits (without medical insurance).

How Medicare works with other insurance

If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer” to pay. In some cases, there may also be a third payer.

What it means to pay primary/secondary 

  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The one that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
  • The secondary payer (which may be Medicare) may not pay all the uncovered costs.
  • If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

Paying “first” means paying the whole bill up to the limits of the coverage. It doesn’t always mean the primary payer pays first in time. If the insurance company doesn’t pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should’ve made.

If you have questions about who pays first, or if your insurance changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627. TTY users should call 1-855-797-2627.

Note:

Tell your doctor and other health care providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays.

What’s a conditional payment?

A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award, or other payment is made.

If Medicare makes a conditional payment for an item or service, and you get a settlement, judgment, award, or other payment for that item or service from an insurance company later, the conditional payment must be repaid to Medicare. You’re responsible for making sure Medicare gets repaid for the conditional payment.

Complete this form to receive information about Medicare Supplement Plans & Medicare Advantage Plans available in your area.

First & Last Name: (*)

Phone Number(*)

Email (*)

Street

City

Zip code

Date of birth

Plans
 Medicare Supplement Plan Medicare Advantage Plans

Comments

Image varification
captcha

By entering your name and information above and submitting the form, you are consenting to receive calls and/or emails regarding your Medicare Supplement plans, Medicare Advantage and / or Prescription Drug Plan options (at any phone number or email address you provide) from a representative or a licensed insurance agent, This agreement is not a condition of purchase.