About Medicare

• Introduction
  
  
• Straight Talk About Medicare - What You Should Know
  
  
• Supplements To Medicare Coverage: What's Out There?
  
  
• Alternative Plans Of Care - What's Out There?
  
  
• Some Basic Things You Should Know

At Blue Cross of California, we know that understanding what Medicare covers and what it doesn't is an important part of protecting yourself against unexpected medical expenses.

That's why we've prepared this guide for you. Read through it carefully before choosing the type of Medicare supplemental coverage that best suits your needs. If you have any questions, please call your Blue Cross Authorized Agent or Blue Cross. We'll be happy to help you in any way we can.

MEDICARE: The Vision Versus the Reality

When Medicare was created, its proponents had a vision that older Americans should be able to enjoy their golden years without the worry that major medical illness and chronic medical conditions could wipe out their life's savings.

It was this vision that led to the creation of the Medicare system. Unfortunately, many people think that they are fully protected under Medicare, and do not discover the truth until it is too late.

As valuable as Medicare is, it has its limitations. It cannot be all things to all people. It covers all or part of many medical expenses -- both hospital and doctor fees. But you are still responsible for deductible and coinsurance payments. Plus, if your doctor does not accept Medicare assignment, your medical expenses could exceed Medicare's approved charges and you would be required to pay the difference out of your pocket.

Protecting yourself against these expensive gaps in Medicare coverage is what supplemental or "Medigap" plans are all about.

MEDICARE PART A: What Does it Cover?

Medicare Part A includes inpatient hospital and skilled nursing facility coverage - but it is important to know that it pays for only part of these medical expenses.

MEDICARE PART B: What Does it Cover?

Medicare Part B is designed to help cover part of your outpatient hospital charges, physician fees, and certain other medical expenses.

The problem is that what Medicare covers and what you have to pay creates "gaps" in your coverage that can add up very quickly.

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There are ten standard Medicare supplemental insurance plans designed to supplement or bridge the gaps in Medicare coverage. These plans are known as Medicare supplement plans and they offer more freedom to choose the hospitals and doctor of your choice than with an HMO. However, you pay a fixed monthly premium for a Medicare Supplement plan. These Medicare Supplement plans vary in what they cover and how much they cost, but generally speaking, the more comprehensive the coverage, the higher the premium.

At Blue Cross of California, we offer a variety of plans specially designed to meet the health care needs of seniors ^_ you choose the coverage and the doctor that's right for you.

The Choices Available through Blue Cross of California

Click on any of these links to learn more about our Medicare Supplement plans.

• ClaimFree^®'Standard Plan A
  
  
• Blue Cross Senior Classic^SM C

   

• Blue Cross Senior Classic F
  
  
• Blue Cross Senior Classic I
  
  
• Blue Cross Senior Classic J
  
  
• Blue Cross Senior Select^SM  
  
  
• Blue Cross Senior Select Plus^SM 
  
  
• Blue Cross Senior SmartChoice
  
  
• Blue Cross Senior AdvantageCare

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Medicare+Choice HMOs

Medicare Health Care Maintenance Organizations (HMOs) contract with the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, to cover health care costs and provide health care to seniors and other Medicare eligibles.

The contract authorizes the Medicare+Choice HMO to provide all health services offered by Medicare, plus many additional services and benefits not provided by Medicare. Most plans require you to select a Primary Care Physician who will coordinate all your medical care, including admitting you to a hospital if medically necessary or referring you to a specialist. Whenever you need medical attention, this is who you will contact. Generally if you go outside the plan for services, you are responsible for the medical expenses. Exceptions are made for emergency services, which you may receive anywhere in the United States, and urgently needed care, which you may receive while temporarily away from the plan's service area.

Depending on the area in which you live, you may have to pay a monthly plan premium, as well as a copayment when you visit a doctor or use other services. You must continue to pay the Part B premium to Medicare, however, your insurance with Blue Cross pays Medicare's Part A and B deductibles and coinsurance.

Blue Cross of California's Managed Care Plan or Medicare HMO

Blue Cross Senior Secure ^SM is an HMO with a Medicare+Choice contract that provides coverage for medically necessary hospital and doctor services. 

Please refer to the Blue Cross Senior Secure page for more detailed information and to determine if this plan is available in your area.

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The National Association of Insurance Commissioners (NAIC) and the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services have prepared a guide that will help you make health insurance choices. This guide does not recommend insurance companies or policies. The purpose of the guide is to:

• Explain your Medicare benefits.
  
  
• Identify what Medicare does not pay in full or at all (the gaps in your coverage).
  
  
• Describe the different types of insurance available to fill the gaps in your Medicare coverage.
  
  
• Provide tips on shopping for private health insurance.
  
  
• List the names and telephone numbers of state agencies that can answer your questions about health insurance.

To receive the "Guide to Health Insurance for People with Medicare" developed jointly by the National Association of Insurance Commissioners and the Centers for Medicare and Medicaid Services (CMS), contact your authorized Blue Cross of California agent or Blue Cross.

Covering Medicare's Gaps

You probably know that there are health care costs that Medicare either does not pay in full or does not pay at all. For example, when you go to the doctor or hospital for services covered by Medicare, you must pay part of the cost.  Other than paying what you owe out of your own pocket, which few people can afford to do, there are four basic ways to help fill the payment gaps in your Medicare coverage:

• By buying Medicare supplement insurance, which is also called "Medigap" insurance.
  
  
• By joining a managed care plan, such as a health maintenance organization (HMO) that has a Medicare contract.
  
  
• By keeping coverage under an employer-provided health insurance policy, if you are eligible for such a policy.
  
  
• By qualifying for state assistance in paying some of your Medicare costs, or for full benefits under the Medicaid program.

What to do First

Before buying additional insurance, you should:

Review any insurance you already have, such as employer-paid coverage, to see whether you need and can afford more insurance.

If you have a low income and limited resources, check with your state to see whether you qualify for Medicaid or for other state help in paying for your health care costs. A few states have programs that help pay for prescription drugs and other medical services. You can find out if yours does by contacting the state office that provides insurance counseling.

Insurance Counseling

Each state offers insurance counseling by trained counselors. The counselors will generally be able to answer your questions about Medicare and private insurance to supplement your Medicare benefits. These services are free.

You can contact a counselor by calling the California Health Insurance Counseling and Advocacy Program Branch at 800-434-0222 or 916-322-3887.

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