Medicare and Supplemental Insurance in California
How Medicare Works
Medicare is divided into four parts, and these parts are named with alphabets A through D. The Medicare C plan is known as the Advantage plan. The Medicare C plan is bought from private insurance firms that have been given the rights to sell the plan from the government. These plans cover only one person. There are some Medicare Advantage plans that cover three parts in one. Let’s see the different parts of each Medicare plan and what they provide:
| Part A: Home care Hospital facility care Nursing care Provision of hospice care | Part B: Care for mental health Provision of medical aids for easy movement Doctor visits Laboratory tests |
| Part C: Dental care Optometrist care Prescription Drugs All the benefits of Parts A and B | Part D: Prescription drugs provision |
Filling in the Gaps in Medicare
There are differences between the Original Medicare Plans and the Medicare Advantage plans. The Medicare Advantage plans provide a lot of benefits in one package. But there are some variations in the way payments are made. The Original Medicare plans (A, B and D) are designed to fulfill specific needs. These plans only require the beneficiary to pay twenty percent of the total treatment cost.
In the Medicare Advantage Plans, you make payments through a copay structure. The copays mean you may have to pay an extra amount to receive a service from the Advantage plan. The Medicare Advantage plan also has an out-of-pocket (OOP) maximum. This means that once a certain amount has been spent by a beneficiary on healthcare in a given calendar year, the Advantage plan covers the rest medical costs for that year. This feature is not available for the original Medicare plans. This means that the –premiums may significantly increase in the event of a serious ailment.
Medicare Supplemental Plan (Medigap)
The state of California has a Medicare Supplemental Plan. This plan is referred to as Medigap and helps just as the name implies to fill some gaps in the Medicare program. The Medigap program helps to provide extra benefits such as the inclusion of co-insurance, deductible payments and co-payments. The Medigap plan mostly helps in providing extra coverage for the Parts A and Parts B of the of the Medicare plan. This plan helps people who desire to switch within parts of the plan to consider an advantage plan rather than a supplement.
California State offers the Medigap program which is divided and identified by letters. The program has a range of insurance coverage for the residents of the state. Insurance plans with identical letters have the same inherent benefits. It is important to note that these plans have different costs. These costs are mostly based on the insurance company that provides the plan or where the plan can be accessed.
There are some provisions in the Medicare plans that do not cover certain ailments or medical aid. For instance, services like stem cell research and cosmetic surgery are not considered under this plan. People benefiting from the plan who need additional prescription drug coverage are encouraged to consider a Medicare Advantage plan with prescription drug benefits or a Medicare D drug plan.
People who wish to become registrants of the Medigap program must register during the six-month window available. This six-month window begins on the first day the intending registrant turns 65 and is already a registrant in the Medicare B plan. Within this period, plan beneficiaries are exempt from any hikes in medical fees, meaning that these people are charged the normal rate and are not denied coverage due to a history of suffering from an ailment. If the plan is changed in the future, the above conditions do not hold.
Another interesting part of the Medicare Supplement Plan in California is the birthday rule. This rule in the state allows Medigap beneficiaries to buy a new plan on or before thirty days after their birthday. However, the provisions state that the plan must be lesser than or equal to their current plan. This rule also exempts Medicare beneficiaries from any medical fee hikes that they would have been subject to at other times of the year.
The best way to choosing a Medicare Supplemental Plan, or Medigap, is to make a choice based on what your needs are. The medical needs of people in a particular area naturally vary. When you have selected the plan you need, the next step is to weigh the cost of the plan with your financial budget. The prices of these plans across companies do vary as the Medigap program is offered by companies in the private sector.
To purchase the Medigap plan, it is compulsory that an individual must be registered in the Medicare Parts A and B. The Medigap plan is regulated by the California Department of Insurance (CDI). The CDI provides dispute resolution and handling of complaints. These complaints may concern premiums, claims, and other issues.
It is also worthy of note that there are going to be some changes in the Medigap plan from January 1, 2020. These changes will not affect the current registrants of the program or individuals that would clock 65 before that date.
Conclusion
The Medicare plan is a plan which provides at least half of the insurance coverage for its beneficiaries. There are variations to the plan. In the state of California, you have to be enrolled in a certain number of Medicare plans to qualify for inclusion into the Medigap program.
