Thursday, July 11, 2024

When Can I Apply For Medicare In California

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General Tips For Working Members Age 65 And Older

How to Qualify for Medi-Cal / Medicaid? – Patrick Phancao Esq. – Medi-Cal / Medicaid Qualification

Four months before your 65th birth month you will receive a letter from CalPERS titled Important Information Concerning Health Coverage at Age 65. This notice contains information regarding the CalPERS Medicare enrollment requirements. We encourage you to carefully review and save this letter for future reference.

We recommend you also review and save all mail received from the Social Security Administration , as it will contain valuable information regarding your Medicare enrollment. You may remain enrolled in a CalPERS Basic health benefits plan until retirement. When you retire, you’ll no longer be eligible to remain in a CalPERS Basic health plan if you are eligible for Medicare Part A at no cost.

Veterans Aid & Attendance Pension

The Aid and Attendance Pension benefit is another program available in California that can be used to pay family members to provide care. At the forefront, it should be mentioned that this program is only relevant for war-time veterans or their surviving spouses who require assistance with their activities of daily living. Spouses cannot be paid as caregivers, but adult children and other relatives can be compensated.

The Aid and Attendance Pension is a cash benefit and the amount of financial assistance varies depending on the beneficiarys current income. Annually, the VA sets a maximum amount of income a beneficiary can have and then the VA supplements the veterans income up to the point of the maximum benefit. For example, in 2021, the Maximum Annual Pension Rate for a veteran and their spouse is $27,765.

For more information about this benefit, read our guide on Aid and Attendance eligibility.

Where Can I Sign Up For Medicare

You automatically get Original Medicare coverage if you get SSDI for two years or start getting Social Security retirement benefits before you turn 65. Otherwise, you may need to sign up.

If you have government-run Original Medicare, you have the options of also getting a privately managed Part D prescription drug policy and, if you are 65 or older, a privately run Medicare supplement policy .

Or, you may decide that you want a privately run Medicare Advantage plan that includes all the benefits you need. Note: Most Medicare Advantage plans include prescription drug coverage, but some allow you to sign up for a separate Part D plan instead.

For all of these types of privately managed Medicare benefits, the signup process is basically the same:

  • You decide which types of plans you want to sign up for.
  • You research the private plans you are looking at. One way of comparing plans is by using the Medicare Plan Finder.
  • You sign up:
  • By calling the Health Insurance Counseling & Advocacy Program at 1-800-434-0222
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    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.

    Option : Medicare Advantage Plans

    California medicare
    • 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.

    Read Also: What Age Do You Apply For Medicare

    Will I Get Medicare At 62 If I Retire Then

    If you retire before the age of 65, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage from a private insurance company until you turn 65. While waiting for Medicare enrollment eligibility, you may contact your State Health Insurance Assistance Program to discuss your options.

    Here are other ways you may be eligible for Medicare at age 62:

    • Or, you have been diagnosed with End-Stage Renal Disease
    • You may qualify for Medicare due to a disability if you have been receiving SSDI checks for more than 24 months
    • Are getting dialysis treatments or have had a kidney transplant

    Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

    Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

    How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In California

    Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare such as long-term care.

    Our guide to financial assistance for Medicare enrollees in California includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

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    About Medicare Supplemental Insurance

    Most people with fee-for-service Medicare find it necessary to supplement their Medicare coverage. This is often done by purchasing additional coverage from a private company. Such insurance is called Medigap because it is specifically designed to complement your existing Medicare coverage.

    There are 12 standard Medigap plans developed by the National Association of Insurance Commissioners. Some or all of the plans are offered in most states. . The 12 standard plans are lettered from A to L. A is the most basic L is the most comprehensive. They pay most, if not all, of Medicare coinsurance amounts, and they may provide some coverage for Medicares deductibles. Some of the plans cover services Medicare doesnt offer, such as outpatient prescription drugs, preventive screening and emergency medical care while traveling outside the U.S.

    Are There Medicare Programs For Those With Low Incomes

    How to Qualify for Medi Cal

    Yes there are two. One is the Qualified Medicare Beneficiary, or QMB program. The other is the Specified Low-Income Medicare Beneficiary, or SLMB program. Both are run by the Health Care Financing Administration and the agency in your state that provides medical assistance under the Medicaid program. If you qualify for the QMB program, your state will pay your monthly Medicare premiums, and you will not have to pay the Medicare deductibles and coinsurance. If you qualify for the SLMB program, your state will pay only your medical insurance monthly premium.

    Only your state can decide if you qualify for help under the QMB or SLMB programs. To find out if you qualify, contact your Medi-Cal office, social service office, or welfare office. For general information, you can ask Social Security for a copy of the leaflet Medicare: Savings for Qualified Beneficiaries .

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    Californias Paid Family Leave Act

    The Paid Family Leave Act allows relatives to take time off from their job to care for a family member. They continue to receive a percentage of their salary while doing so. The actual percentage will vary but in 2021, California generally provides up to 60-70%. While, one is not formally being paid to be a caregiver, they do continue to receive compensation from their job while they are caring for their relative. To be eligible to paid as a caregiver under a href=> PFL Act, one must be related by blood or marriage to the individual who requires care.. One must also be employed and taking time off from their job to provide care. The program allows caregivers to take up to 8 weeks off.

    Can I Get Medicaid Can I Register For Medi

    Any California resident can register for Medicaid through Medi-Cal and other Medi-Cal programs. Since Medi-Cal has more than 90 eligibility categories, applying can help you understand if you fall under one of them. The people who qualify for Medi-Cal can include:

    • Low-income adults

    For more information on Medi-Cal registration in your area, contact your countys social services office.

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    If You Are Younger Than Age 65 With A Disability

    If you are younger than age 65 and receive disability benefits under Social Security Disability Insurance or Railroad Retirement, you will automatically be enrolled in Medicare Parts A and B in the 25th month of your disability payments, or sooner if you have either end-stage renal disease or amyotrophic lateral sclerosis . You will need to to cover your prescription drug benefits.

    During the 24th month of your SSDI payments, Medicare will send you an initial enrollment package containing general information, a questionnaire and your Medicare card.

    If you want both Medicare Part A and Part B , simply sign your Medicare card and keep it in your wallet.

    When Does The Medigap Birthday Rule Apply In California

    Southern California $0 Premium Medicare Advantage Plans

    The birthday rule only applies if youre already enrolled in a Medigap plan in California. It allows a beneficiary to either keep the same plan or choose one with fewer benefits. However, you cannot go from Plan G to Plan F since Plan F has more benefits than Plan G.

    This rule only applies to Medicare Supplement Plans. It does not apply to Medicare Advantage plans.

    If youre outside any enrollment period, you can still apply for a supplement plan at any time of the year. However, youll have to go through medical underwriting during the application process.

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    I Am Considering Medicare Services Through An Hmo What Should I Know

    • The two kinds of HMOs
    • Joining an HMO
    • Possible benefits of belonging to an HMO
    • Possible disadvantages of belonging to an HMO
    • Payment of Medicare and the HMO and
    • Getting out of an HMO.

    The two kinds of HMOs: Most HMOs are risk HMOs. They require you to use only physicians and other medical providers they have approved. They are paid a fixed amount by Medicare for your membership regardless of the cost of your care. If you use medical providers who do not work for the HMO, or are not approved by the HMO, you will be responsible for the bill: Medicare nor your HMO will pay it.

    The other kind of HMO is called a cost HMO. You can use health care providers outside the plan and the bill will be sent to Medicare. When you use cost HMO services, Medicare pays for the cost of services provided to you.

    Joining an HMO: Many HMOs have contracts with the Health Care Financing Administration to serve Medicare beneficiaries. The requirements for your enrollment in these HMOs are:

    • You must be enrolled in Medicare Part B
    • You cannot have elected care from a Medicare-certified hospice
    • You cannot be medically determined to have end stage renal disease .
    • However, if you are already a member of an HMO when you become eligible for Medicare, and that HMO has a contract with Medicare, you can remain in your HMO even if you have ESRD and
    • You must live within the service providing area for which the HMO has a Medicare contract.

    Local Resources For Medicare In California

    • Medicare Savings Programs in California: If your income falls below the government-established amount, you may qualify for help paying your Medicare Part A or Part B premiums. Other programs may be available to help you pay for some drug prescription costs if you qualify.
    • California State Health Insurance and Assistance Program : SHIP is a federal grant program that provides funding to each state. The SHIP grant supports the Health Insurance Counseling and Advocacy Program in California. HICAP provides one-on-one counseling for Medicare beneficiaries in California to help educate them on Medicare plans, benefits, and prescription drug plans.

    Read Also: Can I Get Medicare At Age 62

    Medicare Consists Of 4 Parts:

    • Part A covers inpatient hospitalization hospice home health
    • Part B covers outpatient care, services from doctors and other medical providers, durable medical equipment many preventive services
    • Part C plans that cover all benefits and services under Parts A and B and usually covers prescription drug benefits. Plans may also include extra benefits and services not covered by Medicare such as basic vision and hearing.
    • Part D covers prescription drug costs

    Who Is Eligible For Medicare In California

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    You can qualify for Original Medicare if you are a U.S. citizen or permanent legal resident who has lived in the U.S. for more than five years and one or more of the following describes your personal situation:2

    • Youre 65 or older.
    • Youre under 65, permanently disabled, and receive disability benefits from Social Security or the Railroad Retirement Board.
    • You have end-stage renal disease .
    • You have ALS , also known as Lou Gehrigs disease.

    In 2020, there were 3,612,462 eligible California residents receiving Original Medicare.1 Original Medicare includes Part A, insurance that covers inpatient stays in a hospital, and Part B, medical insurance that covers doctor visits and outpatient services.2

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    Aged & Disabled Federal Poverty Level Program

    If you are aged or disabled and are not eligible for the SSI program, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level program. To qualify, you must:

  • Be aged or disabled .
  • Have less than $2,000 in assets for an individual . Like SSI, this program does not count all of your assets. For more information, see our Medi-Cal Programs Qualification at a Glance chart .
  • Have less than $1,502 in countable monthly income for an individual . These figures include the $20 disregard.
  • This Medi-Cal program uses SSI countable income rules as well as a few extra rules you should know. For more information, visit the Medi-Cal section of the Disability Benefits 101 website.

    Other Ways To Get Medicare Coverage At Age 65

    If you dont qualify for premium-free Medicare Part A coverage, you may still be eligible to buy coverage.

    You still have to be a U.S. citizen or a permanent resident for at least five years.

    Other Medicare Eligibility Options

    • You can pay premiums for Medicare Part A hospital insurance. These vary on how long you have worked and paid into Medicare. If you continue working until youve totaled 10 years of paying into the system, you wont have to pay premiums anymore.
    • You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
    • You can pay monthly premiums for Medicare Part D prescription drug coverage. This is the same as anyone else would pay depending on the plan you choose.

    You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare Medicare Parts A and B.

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    % California Working Disabled Program

    The 250% California Working Disabled program helps Californians who are working, disabled and have income too high to qualify for free Medi-Cal. Californians who qualify may be able to receive Medi-Cal by paying a small monthly premium based on their income. Premiums range from $20 to $250 per month for an individual or from $30 to $375 for a couple.

    To qualify, you must:

    Also learn about how AB 1269 made the California Working Disabled program event better. This bill was signed into law in 2009 and became effective August 2011.

    All these CWD rules are explained in more detail in the Medi-Cal section of the Disability Benefits 101 website.

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    Why Are Medicare Part D Rules So Confusing?

    There are multiple programs in California that pay family members to care for a loved one. However, both the caregiver and the care recipient must meet certain eligibility requirements.

    In California, there are several programs that will pay family members to provide non-medical, hands-on assistance for a loved one. But, its important to realize that not everyone will be eligible to participate in these programs. For example, ones income, veteran status, marital status, the value of their assets, whether or not they are currently employed, and the type of insurance they have can all impact their eligibility for paid caregiver programs. Another major factor is ones blood relationship to the individual who requires care. Some programs only allow certain relatives to be paid and other programs prohibit certain family members from being compensated.

    This article will describe the different programs available in California, how they work and briefly touch on their eligibility requirements. Alternatively, readers may want to use the Paid Caregiver Program Search Tool. The tool helps caregivers and care recipients find programs for which they are eligible simply by responding to a series of questions.

    Helpful Resources

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    How And When Do I Apply For Medicare

    Medicare applications are handled through your local Social Security office and are usually submitted when you apply for Social Security. To ensure that your entrance into Medicare is problem-free, you should contact your local Social Security office within three months before you turn 65. If you fail to enroll within this three-month period, youll have to pay a penalty for late enrollment. This time frame is important particularly for those who have retired or plan to retire before age 65.

    Medicare becomes effective for people following the regular application process on the first day of the month in which they turn 65. What does Part A of Medicare cover? Part A helps pay for Hospital Inpatient care. For each benefit period, Medicare pays all covered costs except the Part A deductible during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. A benefit period begins when you are admitted to a hospital and ends when you have been out of the hospital or have not received skilled care in a nursing facility for 60 consecutive days. In addition to this benefit period, you are given 60 lifetime reserve days that can be used only once.

    IMPORTANT: Medicare does not pay for custodial care if it makes up the bulk of services received in a nursing facility. . Because many people in nursing facilities receive this type of care, it may be useful for you to keep in mind that Medicare does not pay for it.

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