More than 4 million people use Medicare in California as of 2010.
Medicare is a U.S. health insurance program meant mainly for senior citizens. Medicare comes in four parts, named A through D, and covers inpatient and outpatient hospital services, preventive health screenings, prescription drugs, home health and hospice services. Parts A and B can be obtained through the federal government, while C and D are bought from private insurance companies. Insurance companies also sell supplemental Medicare plans, but their benefits are standardized. As of 2010, California seniors can choose from 10 Medigap plans, although they don't need them if they have full health coverage from Medi-Cal.
Open Enrollment
If you are 65 or older or have Medicare because of a disability, you start an open enrollment period for Medigap on the day you begin receiving coverage for Medicare Part B. California law also requires you to have open enrollment for Medigap if you move out of the service area for a previous Medigap plan, lose military health coverage, lose Medi-Cal benefits or if your employment-based or retirement health coverage ceases. During open enrollment, you cannot be refused for a policy or be required to take a health screening. People 65 and older can buy any available plan they want; people younger than 65 can buy plans A through F, K and L.
Premium Pricing
Insurance companies in California are allowed to set their prices for Medigap policies in three possible ways. The most common is called attained-age pricing, where premiums increase as you get older. Another is issue-age rating, in which your premiums depend on your age when you first buy your policy and do not increase as you get older, although they may for other reasons. The third and least common is called community or no-age rating, where premiums are the same for everyone, regardless of their ages.
Benefits
All Medigap plans in California offer the same basic benefits. These include all of the hospital coinsurance for Medicare Part A, 100 percent of 365 days of hospital stays after Medicare ceases, the coinsurance for Part B, cost sharing for hospice and the cost of the first three pints of blood per calendar year. Some plans also include additional benefits, like skilled nursing facility co-payments, 100 percent of Medicare Part B excess charges and coverage for health emergencies that occur while traveling outside the United States.
High-Deductible and Cost-Sharing Plans
If they so desire, Medigap buyers in California can pick either a high-deductible plan or a plan with a yearly out-of-pocket cost. Plan F is available as both regular and high-deductible policies. The benefits are the same, but the high-deductible plan has an annual $2,000 deductible before Medigap pays any claims. Plans K and L are cost-sharing plans. K has a yearly out-of-pocket limit of $4,620 and covers 50 percent of some benefits, while L's annual out-of-pocket is $2,310 and covers 75 percent.
Tags: health coverage, Medicare Part, open enrollment, although they, common called
