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About
Medicare
Outside of
California Click
here |
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Introduction |
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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. |
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Straight Talk
About Medicare - What You Should Know |
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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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Supplements
To Medicare Coverage: What's Out There? |
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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.
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Alternative
Plans Of Care - What's Out There? |
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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.
Anthem Blue Cross's Managed
Care Plan or Medicare HMO
Anthem 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 Anthem
Blue Cross Senior Secure page for more
detailed information and to determine if this
plan is available in your area.
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Some
Basic Things You Should Know |
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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.
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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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Oleg
Skurskiy Authorized Independent Agent
for Anthem Blue Cross (in California), Anthem
Blue Cross and Blue Shield (in Colorado, Connecticut,
Nevada and New Hampshire) and Blue Cross Blue
Shield of Georgia. Independent licensees of
the Blue Cross Blue Shield Association
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Copyright © 2005 Oleg Skurskiy Authorized
Independent Agent, CA License 0E50389 |
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