Federal regulations guide supplement plans in California.
Medicare is a federal government program that provides health coverage to people age 65 and older, certain disabled people under age 65, and people of any age treated with kidney dialysis or a transplant. Federal regulations guide supplement plans in California and all but three other states.
Medicare Benefits
The Medicare program provides benefits in four areas. Part A helps pay for inpatient hospital, skilled nursing facility, some home health and hospice care. Part B helps pay for doctors' services and outpatient hospital services. It also covers diagnostic tests, ambulance transportation, durable medical equipment and supplies, and preventive care, including mammography and Pap tests. Part C covers the Medicare Advantage plans that are run by private companies. These plans provide all Part A and Part B benefits and often provide additional benefits such as vision, hearing and wellness programs. Part D involves the prescription drug plans.
Supplement Plans
When you buy any one of the 12 supplemental plans, it contains the same basic benefits across the United States by law, except for Wisconsin, Minnesota and Massachusetts. The individual insurance company may offer additional benefits as long as they cover the required benefits. Supplemental insurance is often called "Medigap" insurance because it can cover co-payments, deductibles and other selected expenses not covered by Medicare. The price for any plan is influenced by added benefits and your age.
People in the Medicare Advantage program usually have no need for supplemental insurance.
When you first become eligible for Medicare, you have six months to sign up for the supplement plan of your choice. Annual open enrollment starts on your birthday and lasts for 30 days. If you decide to go with a new plan, it must be of equal or lesser value than your current plan.
The Core Benefits Plan
The least expensive supplemental plan has three mandatory benefits. The first is hospitalization. It pays for co-insurance (co-payments) after the 60-day period not covered by Medicare. The second is blood. It pays for the first three pints of blood, which are not covered by Medicare. Third is the 20 percent co-payment required under Medicare for the approved payment amount under Part B for doctors' services.
Other Plans
All remaining 11 plans include these three benefits plus some combination of seven other benefits. These seven benefits are Part A deductible costs, Part B deductible costs, skilled nursing co-payments, excess doctor's fees at 80 or 100 percent, foreign travel emergency costs, home health-care costs and uncovered preventive care costs.
California's Program
California's Department of Insurance oversees all of the companies that provide supplemental insurance, except for health maintenance organizations (HMO). The federally mandated Health Insurance Counseling and Advocacy Program (HICAP) is administered in California by the Department of Aging. It has offices in every county that provide authoritative information and can provide advice.
Tags: covered Medicare, additional benefits, California Department, deductible costs, doctors services, Federal regulations
