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Medicare

Latino senior at a family picnicAlmost everyone age 65 or older has Medicare. Medicare is the federal health insurance for people who are 65 and older and for some people under 65 who have a disability.

Some people have Original Medicare and other people have a Medicare Advantage plan.

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Medicare Advantage plans

Medicare Advantage plans include HMOs, PPOs, and some other types of plans. 

In a Medicare Advantage plan, you must get all your benefits through your plan. Plans have rules about the doctors you can see and the costs you pay.

If the plan does not offer prescription drug benefits, you can buy a separate Part D prescription drug plan.

To learn more:

  • Check out the OPA Senior Guide . This guide can help you know how to choose and use a Medicare Advantage HMO or PPO.
  • Compare Medicare plans at www.medicare.gov. This is the official federal website on Medicare. The website's Medicare Plan Finder includes star ratings on quality.
  • View the Report Card on California's Medicare Advantage physician groups.

 

Original Medicare

In Original Medicare, you can see any doctor who takes Medicare. Some doctors accept Medicare but do not accept the Medicare-approved amount as the full payment for services. You pay more to see these doctors.

You can buy Medigap (supplement) insurance to help pay the costs that Medicare does not cover. Learn more at www.medicare.gov. This is the official federal website on Medicare.

 

Medicare health care quality ratings

You can view star ratings on Medicare Advantage plans through its Finder tool. The Medicare website also has quality information about health care facilities on:

 

Medicare prescription drug coverage

Medicare Part D is Medicare prescription drug coverage. If you have Original Medicare, or your Medicare Advantage plan does not have prescription drug benefits, you can buy a separate Part D prescription drug plan.

Part D is changing under health care reform. The gap in coverage, called the "doughnut hole," will get smaller each year. In 2020, the doughnut hole will end.

Learn more about Part D at www.cahealthadvocates.org.

 

If you have both Medicare and Medi-Cal

The Medi-Cal program helps Medicare beneficiaries with low incomes get some kinds of care that Medicare does not cover. For example, Medicare does not cover long-term care in a nursing home.  

California has a new project in 8 counties to coordinate care for people who have both Medicare and Medi-Cal (also called dual eligibles).  Learn more...

 

Help with Medicare questions and problems

California's HICAP program provides free help with many kinds of Medicare questions and problems. HICAP is the Health Insurance Counseling and Advocacy Program. Call 1-800-434-0222 or visit www.aging.ca.gov/hicap.

Learn more about Medicare problems and complaints

 

Resources

California's HMO Guide for Seniors

HICAP (Health Insurance Counseling & Advocacy)

1-800-MEDICARE

Social Security Administration 

Health Plan Problems?

For HMOs  888-466-2219
For PPOs   800-927-4357

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