Medicare

Our Medicare Plans include:

What is Medicare and Do I Qualify?

Medicare is a federal health insurance program comprised of four main parts: Parts A, B, C and D. Together, Parts A and B are known as 'Original Medicare' offered by the government.

United States citizens 65 and older OR those that have been legal residents for at least 5 years and are 65 and older and them or their spouse have worked for at least 10 years (or 40 quarters) in Medicare-covered employment are eligible for Medicare coverage. Someone also may be eligible for Medicare younger than 65 if they meet criteria for certain disabilities. Requirements may vary among the different Medicare plans.

Please click the link to see if you are eligible for Medicare and to calculate your premium.

Medicare Part A Eligibility Hospital Insurance:

• You're at least 64 years and 9 months old, or;
• You're under 65, but live with a certain disability or conditions; or
• You have end-stage renal disease (ESRD).

Medicare Part B Eligibility Medical Insurance:

• You're at least 64 years and 9 months of age, or;
• You're under 65, but live with a certain disability or condition; or
• You have end-stage renal disease (ESRD).

Medicare Part C Eligibility (Medicare Advantage Plans – offered in California):

• You're entitled to Part A, and;
• You're entitled to Part B, and'
• You do not have end-stage renal disease (ESRD), unless you meet an exception, and;
• You live in the plan's service area.

Medicare is a federal health insurance program with very specific enrollment rules to navigate which we will cover in this article.  Go here to read more about the  four parts of Medicare.

As with the other states, there are private companies that operate in the state of California that offer health care plans that work in together with Medicare to provide health insurance to qualifying individuals. We will go into detail in this article.

California Medicare Eligibility Guidelines

There are four ways to become eligible for Medicare in California:

• You are 65 or older
• You have End-Stage Renal Disease (ESRD)
• You have Lou Gehrig’s Disease (ALS)
• You currently receive Social Security Disability Insurance (SSDI) for 25+ months.

Once you have confirmed eligibility requirements have been met, you can then begin shopping the various health plan solutions.

To learn more please click HERE.

Medicare Health Plans in California

Even though there are hundreds of health insurance plan options for Medicare in California, there may only be a select few that are available to you and that make sense for your needs. Keep in mind that Original Medicare (the government-sponsored health insurance plan) is NOT the same thing as privately owned California Medicare Advantage and Medicare Supplement plans.

Original Medicare is made up of Part A and Part B and is what you will first start with when you become eligible for Medicare. You can read more about the 4 parts of Medicare here.

Once you have Part A and Part B, most people will make a decision between enrolling in the following options.

• Medicare Advantage plan with Medicare Part D prescription drug coverage.
• Medicare Supplement with Medicare Part D prescription drug coverage.
• Stand-alone prescription drug coverage (part d) plan.

Medicare Advantage Plans in California

Medicare Advantage plans in California are great options for those who want additional health insurance benefits than what's available strictly through original Medicare.

Contrary to what you may have heard, Medicare advantage plans still require you to have all your Part A and Part B benefits, but may also have more!

Additional health insurance benefits may include:

• Fitness programs
• Meal delivery
• Dental
• Vision
• Hearing
• Non-emergency transportation

Need help making your California Medicare enrollment decision? We suggest that you make a list of the health care benefits that you need before you start shopping for Medicare coverage from any insurance company. Also, make a list of the doctors and pharmacies you like to visit, and the prescriptions that you are currently taking. Make sure that the plan you select will cover all of your needs.

Medicare Advantage Plans Enrollment Details

Enrollment in Medicare Advantage Plans occurs annually between October 7th and December 15th. This is called the Annual Election Period is the the period of time that the majority of Medicare Advantage plan enrollments occur.

If you are just turning 65 and becoming eligible for Medicare, your initial enrollment date will be effective the 1st day of your birth month. For example, if you're birthday is May 15th, your Medicare effective date will be May 1st.

Medicare Supplement Plans in California

If Medicare Advantage isn’t right for you, you may want to consider Medicare Supplement plans instead.

These plans are often called “Medigap,” because they close the gap between what Medicare covers and your out-of-pocket costs.

Medigap plans usually do not include all the extra benefits that Medicare Advantage plans can provide. Instead, Medigap plans can cover your Part A and Part B premiums, deductibles, co-payments, and coinsurance.

What is the Cost of Medicare in California?

If you stick to the basics (Part A and Part B), your costs will be standardized.

Most people will have premium-free Part A (unless you did not pay Medicare taxes throughout your life). The standard Part B premium for 2022 is $170.10 per month.

Click Here for more information on cost of Medicare.



California’s Medicare Part D Prescription Drug Discount Program

Did you know that California Medicare recipients have access to Medicaid-level drug pricing?

Regardless of the prescription drug coverage you have, as long as you have your Medicare card to prove that you have Medicare coverage, you can get great discounts.

When you pick up your prescriptions, show your Medicare card to the pharmacy and ask for the Medi-Cal reimbursement price. If the Medi-Cal price is lower, they can give you that price instead.

Be aware that if you have a great Part D or Medicare Advantage plan, there is a chance that it will actually be cheaper for you to use your Medicare plan than using the Medi-Cal discount.

Always make sure that the price is actually lower before going that route. Additionally, know that only pharmacies who accept Medi-Cal coverage can offer this discount price, so your favorite pharmacy may not participate in this program.

Can I Have Medicare and Medicaid in California?

Medi-Cal is what is referred to those in California with Medicaid benefits.

If you qualify for Medicare and meet the income requirements for California Medicaid (Medi-Cal), you may qualify for plans that have benefits from both programs, which is referred to as Dual Special Needs Plans (DSNP). These types of Medicare Advantage plans were specifically created for this scenario.

DSNPs generally cover most, if not all, of your health care costs.

How Do I Enroll and Do I Qualify for Medicare?

Ready for enrollment into Original Medicare? For most, enrollment is automatic for Part A upon turning 65. If you are not automatically enrolled, or if it is time for you to enroll in Part B, your options are:

Visit www.socialsecurity.gov

Call Social Security at 800.772.1213 (TTY 800.325.0778)

Visit your local Social Security office in Alameda, Contra Costa, Placer, Sacramento, Santa Clara and Yolo Counties.

• Alameda County Social Security Office Locations
• Contra Costa County Social Security Office Locations
• Placer County Social Security Office Locations
• Sacramento County Social Security Office Locations
• Santa Clara County Social Security Office Locations
• Yolo County Social Security Office Locations

Download the Medicare application you need and mail it in or bring it to your local Social Security office.

Conclusion

Medicare can be a complex program to understand and Nivano is dedicated to making it easier for you to to navigate in order to make the best decision possible for you. 

If you have specific questions, feel free to reach out to the Nivano Medicare Hotline at 866-674-3959, we have state licensed agents standing by to answer all your questions.

About Nivano Accepted Medicare Plans: Nivano Physicians proudly services Medicare members in Alameda, Contra Costa, Placer, Sacramento, Santa Clara and Yolo Counties through Anthem Blue Cross and Imperial Health Plan. Here is a link to more information on Nivano accepted Medicare plans. The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.