Wednesday, July 10, 2024

How To Get Medicare In California

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California Medicare Advantage Plans For 2023

CalPERS Quick Tip | Medicare

Lindsay MalzoneReviewed by Licensed Insurance Agent: Rodolfo Marrero

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In California, millions of residents have chosen private Medicare Advantage plans over their Original Medicare coverage options. Los Angeles alone reports over 793,000 Medicare Advantage beneficiaries, with at least seven other counties reporting numbers in the hundreds of thousands.

As with all medical decisions, its essential to understand what Medicare Advantage is, the types of plans available, and what this type of coverage may cost before making a commitment or changing plans.

If you or a loved one is considering switching from Original Medicare coverage, read below to learn how California Medicare Advantage Plans may help.

Transitioning To A Medicare Health Plan

When you retire, become Medicare eligible, and enroll in Medicare Part A and Part B, you’ll have the option to choose a new Medicare health plan. If you do not choose one, CalPERS will enroll you in a CalPERS Medicare health plan.

Your current health carrier offers a CalPERS-sponsored Medicare health plan CalPERS will enroll you in your current health carrier’s Medicare health plan
Your current health carrier does not offer a CalPERS-sponsored Medicare health plan CalPERS will enroll you in the UnitedHealthcare Group Medicare Advantage PPO Plan.

Get Started With Medicare

Medicare is health insurance for people 65 or older. Youre first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease , or ALS .

Follow these steps to learn about Medicare, how to sign up, and your coverage options. Learn about it at your own pace.

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Who Is Eligible For Medicare

You are eligible for Medicare if you are a citizen of the United States or have been a legal resident for at least 5 years and:

  • You are age 65 or older and you or your spouse has worked for at least 10 years in Medicare-covered employment.
  • You are age 65 or older and you or your spouse has worked 30-39 quarters in Medicare-covered employment.
  • You are age 65 or older and you or your spouse has worked 0-29 quarters in Medicare-covered employment. You must enroll as a voluntary enrollee and pay the full Part A monthly premium. Note:Low-income programs can help you pay these premiums if you meet the income and asset levels.

Check With Your Doctor And Specialists To See If They Take Medicare Patients


To receive benefits under any UC-sponsored Medicare plan , you must use a provider who accepts Medicare. For Kaiser, this Medicare provider must also be within their associated network. If you see a doctor outside of your provider network or one who does not take Medicare members or will only render services under a private contract directly with you, neither Medicare nor your UC-sponsored medical plan will cover the services. Check with your current providers to see whether you need to change your doctor or be prepared to self-pay for these services.

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What Are The Different Benefits Categories For Medi

Medi-Cal Benefits are broken down into 14 categories. Medi-Cal benefits are a comprehensive set of health benefits that may be utilized when necessary. Beneficiaries may receive free coverage, partial pay coverage, or coverage for specific services. Depending on your medical needs, coverage may be short term or ongoing.

Ambulatory Patient Services

  • Home and community based care

How To Apply For Medicare In California

When you turn 65, you will have a multi-month window to get Original Medicare. You can enroll in the three months leading up to your 65th birthday and the three months after.

You can also purchase Original Medicare by phone if you call 1-800-772-1213, or online as well. Those who are already taking Social Security are automatically enrolled.

Medicare Advantage plans are available as separate plans through private insurers, so you can get Medicare coverage through those companies.

You are eligible to buy Medigap within a six-month window once you enroll in Original Medicare.

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Do I Have Choices In How I Receive Medicare Benefits

Yes there are two choices. You can either use the traditional fee-for-service delivery system, in which you visit a hospital or doctor of your choice and pay a fee for services rendered, or you can join a Health Maintenance Organization with a Medicare contract. An HMO is a network of health care providers that offers comprehensive health care coverage.

Can You Be Enrolled In Both Medi

Medicare and Your CalPERS Health Benefits

There are currently 1.6 million beneficiaries in California who qualify for both Medicare and Medi-Cal.

Being dual eligible for both programs is a result of meeting the eligibility criteria for each. For example, you can qualify for Medicare by being older than 65 and qualify for Medi-Cal because of having a low income.

For those enrolled in both programs, Medi-Cal and Medicare work together in coordinating and providing care. With this type of arrangement, Medi-Cal wraps around Medicare coverage, helping to pay for Medicare premiums, copayments and deductibles.

Medi-Cal also provides additional benefits beyond what’s usually included with Medicare Parts A and B, covering prescription drugs, dental, vision care, extended stays in skilled nursing facilities and long-term care in nursing homes.

Please note that those who have a low income may qualify for free or low-cost prescription drug coverage through Medicare’s Extra Help program.

In addition, there are many Medicare Advantage plans offered in California, including Special Needs Plans that are specifically designed for those who are dual eligible for Medicare and Medi-Cal.

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California Medicare Eligibility Requirements In 2022

Entering into Medicare often marks the beginning of retirement for many Americans. Since health care is increasingly important as we age, making the most of Medicare is a key part of anyones plan for living a vital and enjoyable life in retirement. To be prepared, you need to know when youll enter Medicare. Read this brief guide to California Medicare eligibility requirements in 2022 to be ready for your retirement journey.

Cancellation Of Calpers Health Coverage

If your CalPERS Basic health plan coverage is canceled because you did not provide supporting documentation to meet the requirements to continue your CalPERS health coverage after age 65, you can request reinstatement of your health coverage within 90 days of your cancellation. In your request for reinstatement, you must provide supporting documentation from the SSA.

You may also request re-enrollment through an administrative review process after 90 days of the date the coverage is canceled.

Submit your request for reinstatement of health coverage to:

CalPERS Health Account Management DivisionAttention: Medicare AdministrationP.O. Box 942715Sacramento, CA 94229-2715

If your coverage isn’t reinstated, you may re-enroll during the annual Open Enrollment period by providing a completed Certification of Medicare Status form along with the required documentation.

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There Are Some Things You Should Be Aware Of When Considering Medigap Coverage

  • You should know that most of these policies place a maximum limit to the amount of benefits they will give you within a defined time period.
  • You should know that some Medigap policies may not cover certain health conditions for the first six months. By federal law, all Medigap policies are required to cover your preexisting health condition after they have been in effect for you for those six months.
  • Be careful not to be sold duplicate coverage you dont need. There are various anti-duplication provisions enacted into federal law to discourage anyone from selling you such duplicate coverage. Call 1-800-638-6833 for suspected violations.
  • In some states, insurance companies may refuse to renew a Medigap policy bought before 1990. During this time, state law was not requred to say the Medigap policies had to be renewed automatically each year.

Medicare Part D And Calpers Medicare Health Plans

Medicare 101: The Letter At The End Of My Medicare Number

CalPERS participates in a Medicare Part D prescription drug plan for members enrolled in a CalPERS Medicare health plan.

The standard Part D premium is paid through your CalPERS health insurance premium. If your income exceeds a federal threshold as determined by the SSA, you may be subject to an additional Income Related Monthly Adjustment Amount for Part D prescription drug premiums. You’ll either receive an invoice for the additional amount, or it’ll be deducted from your Social Security benefits. Non-payment of the additional prescription drug premium will result in cancellation of your CalPERS health coverage.

If you enroll in a CalPERS-sponsored Medicare Advantage Plan that includes Part D prescription drug coverage in its benefit package and you are subject to an additional Medicare Part D premium, you must pay the additional Medicare Part D premium, or your health coverage will be canceled. If you re-enroll at a later date, you may incur a federal late enrollment penalty.

Do not enroll in a non-CalPERS Medicare Part D plan. If you do so, CMS will disenroll you from your CalPERS-sponsored Medicare Advantage Plan or Medicare Part D prescription drug plan resulting in cancellation of your CalPERS health coverage and you’ll be responsible for your prescription drug costs.

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Federal Poverty Level Eligibility For Medi

Medi-Cal programs offer multiple levels. Depending on income, you may qualify for Medi-Cal that is free to you, or you may qualify for Medi-Cal that is requires you to share in the cost. This means you would be required to pay for a portion of your medical services.

In determining income eligibility for Medi-Cal, your monthly income will be considered. The table below shows the FPL by family size.

Family Size


Help For Medicares Beneficiaries In California

Because California is home to so many beneficiaries, there are many programs in the state that offer financial assistance and information about Medicare in California

California Medicare Savings Programs: Depending on your income, you may qualify for help paying your Medicare Part A or Part B premiums. There are also programs that help pay for some of your prescription costs. Your income must be below a certain limit to qualify.

California State Health Insurance and Assistance Program : SHIP is a federal grant that provides funding to each state to offer Medicare information and counseling. In California, the SHIP grant supports the Health Insurance Counseling and Advocacy Program . HICAP offers one-on-one counseling for Medicare beneficiaries in California. HICAP also provides information on Medicare plans, benefits, and prescription drug plans in California.

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If I Am Considering Medicare Fee

You should know about assignment, which will affect how much you pay for Medicare services. You should also know about Medicare supplemental insurance, which you will probably need.

About assignment:

Some health care providers who accept Medicare patients accept something called assignment. Providers accepting assignment agree to charge only prices that Medicare approves. Providers who do not accept assignment can charge up to 15 percent more than Medicare-approved prices by federal law.

Here is an example of how assignment affects you:

Providers actual charge for a service: $200
You pay 20% of approved charge : $20

If the provider accepts assignment, youre total cost is $20 . If the provider does not accept assignment, you are responsible to pay 15 percent more than Medicares approved charge. Fifteen percent more than $100 is $15. Your total cost is $35 .

Before using a providers service, ask first whether that provider accepts Medicare. Second, ask whether he or she accepts Medicare assignment. A provider who does not regularly accept assignment may do so on a case-by-case basis. Ask whether he or she is willing to accept you individually on an assignment basis.

Providers who accept assignment will not necessarily refer you to specialists who accept assignment. Ask your provider to try, whenever possible, to send you to specialists who accept assignment.

California Medicare Eligibility Requirements In 2022 For Private Medicare Plans

How to get local Medicare enrollment help

Once youre enrolled in Original Medicare, youll have the opportunity to enroll in a Medicare Insurance plan from a private insurance company. Most people do this in order to limit their out of pocket spending, and to get access to benefits beyond what Original Medicare offers. The three main kinds of private Medicare plans are:

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Medicare Eligibility In California

California is the most populous state in the U.S. and includes everything from massive cities to small towns. This variety also means that there are many different forms of Medicare available to you depending on if you live in a rural or urban city.

If you opt for the federally funded Original Medicare, then your eligibility is the same as essentially anywhere else in the country. You must also be 65 years old and have paid Medicare taxes while working. You also can be eligible for Medigap, which helps you cover some of the costs associated with Original Medicare, like copayments, coinsurance and deductibles.

Additionally, California has numerous local options available through Medicare Advantage, which can vary . These plans are available through private insurance companies and will cover at minimum everything included in Original Medicare. Medicare Advantage plans often include added benefits and coverage.

According to the U.S. Centers for Medicare & Medicaid Services, 99% of California residents with Medicare have access to a Medicare Advantage plan.

Possible Benefits Of Belonging To An Hmo:

  • HMOs with Medicare contracts provide all hospital and medical benefits covered by Medicare. Many of these HMOs provide benefits beyond those Medicare pays for. These may include preventive care, prescription drugs, dental care, hearing aids, and eyeglasses.
  • HMO users do not have to pay the co-payments and deductibles of Medicare, nor do they need Medigap insurance.
  • HMO copayment amounts are generally lower than what Medicare asks for, if they exist at all. HMOs do not usually have deductibles.
  • Unlimited lengths of hospital stay are generally covered entirely by an HMO: in other words, you can return to an HMO for hospital services many times over for long periods of time without fear that benefits will end.
  • The coordination of services at an HMO could enhance the quality of your health care. There is very little paperwork involved when using a HMO, and it can be easier to get all your health services from one health care source.

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Why Should I Choose A Uc Medicare Plan Instead Of One Of The Other Medicare Plans I See Advertised

You may already be receiving ads for commercial health plans and you can probably just recycle them. If youre eligible for UC retiree health benefits, a UC Medicare plan is likely to be your best option.

Because UC values its retirees and their service, it is projected to contribute over $300 million to health plans for retirees and their family members in 2021. UC has also negotiated with insurance companies on your behalf to ensure these plans offer as much protection as possible, with an upper limit on your out-of-pocket costs and help with appeals if you need it.

Medicare Part D for prescription drugs is folded into your UC Medicare plan . If you enroll in these commercial Medicare health and/or Medicare Part D prescription plans, your UC Medicare plan will be terminated automatically.

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I Want To Sign Up For Only Part A Or Both Part A & Part B

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Once youre eligible to sign up for Medicare , you have 2 options:

  • Sign up to get only Medicare coverage.
  • Apply to start getting benefits from Social Security . Once youre approved to start getting benefits, youll automatically get Part A coverage. Youll choose if you want Part B coverage when you apply for benefits.
  • Once you sign up , youll get a welcome package with your Medicare card.

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    How To Apply For Medicare In Person

    For something as important as health insurance you might think that apply for Medicare in person at your local Social Security office is the only way to go. This can be a convenient option if you are very close to turning 65 and need to get your application processed quickly.

    We recommend that you visit the social security website to search for the office nearest you. We also recommend that you call before hand and confirm what documents they will need to process your enrollment into Medicare Part A and Part B. This will ensure you come prepared. For your convenience we have created a quick link below to their website search function which will hep you find your local office.

    Documentation is key when it comes to almost everything that is important. When it comes to Medicare insurance this is no exception to the rule. Once you have finished enrolling into Medicare Part A and Part B at your local Social Security office, ask for proof of coverage being activated. This print out should include the following information: Part A and Part B effective dates and your Medicare ID number. By doing this, it should speed up the process for us to help you take the next steps of enroll into a Medicare Advantage plan or a Medicare Supplement plan.

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    Option : Medicare Advantage Plans

    • Medicare Advantage Plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.
    • In Orange County, Medicare Advantage are either an HMO or PPO. Plan members are assigned a medical group and referrals are required prior to seeing a specialist. MA plans pay first, and Medi-Cal pays any remaining cost sharing amounts. Beneficiaries need only present their MA Plan card when obtaining medical services.

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