Note: If you are new to Medicare it is important to select appropriate additional coverage.
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Important Timing Issues:
- It is important to make timely decisions about the Medicare plans you wish to have. You can make choices during your initial enrollment period or a special enrollment period, if you’re entitled to one. If you do not join a Prescription Drug Plan or a Medicare Advantage Plan your coverage will revert to Original Medicare with no Part D prescription coverage. You may have to wait until the next fall open enrollment period to enroll in one of these plans. In that case coverage won’t be effective until January of the following year.
- If you have Original Medicare you generally will have a 6-month open enrollment period after you are first enrolled in Medicare Part B to purchase a Medigap policy (Medicare supplement.)
- You can also join a 5 star Medicare Advantage plan at any time. You have this right once per year. Kaiser Senior Advantage is the only 5 star plan in Contra Costa County
- If you qualify, you can join a Chronic Special Needs Medicare Advantage Plan at any time. These plans are only for people who have specific chronic conditions or who are receiving care in an institution.
- If you don’t have prescription drug coverage you may be subject to a late enrollment penalty.
Avoid problems. Here is a list of HICAP counseling locations throughout Contra Costa County with phone numbers and make an appointment for one-on-one counseling.
Read on for information about each of your options and to see charts of all the choices available in Contra Costa County this year.
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Medicare Advantage Plans with Prescription Drug Coverage
Medicare Advantage (MA) plans are private insurance plans approved and subsidized by Medicare. They offer equivalent benefits to Medicare and are an alternative way of receiving Medicare coverage. Joining a Medicare Advantage plan means you may not use your Medicare card outside the plan. When considering a Medicare Advantage Plan, beneficiaries should confirm that their preferred physicians, physician groups, and hospitals are covered by the plan, as well as their prescription medications.
Unless you are in your initial Medicare enrollment period or a special enrollment period, you can only join a plan during fall Open Enrollment, which occurs each year between October 15th and December 7th. An exception to this rule is offered for a 5-Star Plan.
You can normally only leave a plan during Open Enrollment except during the special Medicare Advantage Open Enrollment period, which is from Jan. 1 to Mar. 31 each year. During that time you can go back to Original Medicare and enroll in a stand-alone Prescription Drug Plan. If you are already enrolled in a Medicare Advantage plan, you have a one time option to switch to a different Medicare Advantage Plan during this special open enrollment period.
Click here for details about the Medicare Advantage plans offered this year.
Specialized Medicare Advantage Plans, most with Prescription Drug Coverage
There are specialized Medicare Advantage Plans available for those who meet specific criteria. Some of these plans have different rules for enrollment. These specialized plans include:
Plans for Full Duals (offered only for persons who have Medicare and full scope Medi-Cal)
Plans for people with chronic medical conditions or who are receiving institutional care.
Premium Reduction Plans for people who are covered under non-Medicare insurance (such as VA).
Medigap (Medicare Supplement) Policies
Medigap (Supplement) policies are private insurance policies designed to pay the portion of covered medical costs that Medicare does not pay—that is, the deductibles and coinsurance. Medicare pays its share of the Medicare-approved amount, then your Medigap policy pays its share. Different Medigap plans are offered, designated by letters (A-N), but all plans with the same letter designation offer the same coverage. Some plans will pay all the deductibles and co-insurance.
Click here for detailed information about Medigap policies.
Stand-Alone Prescription Drug Plans
Stand-Alone Prescription Drug Plans are normally for those who do not enroll in a Medicare Advantage Plan. That includes those who elect to use just Original Medicare or who also select a Medigap Policy.
Click here for a chart of Stand-Alone Prescription Drug Plans.
Full Duals Medicare Advantage Plans
Some plans are available primarily to “dual eligibles” – persons with both Medicare and full scope Medi-Cal (with no share of cost). The Kaiser Medicare-Medi-Cal Plan is ONLY for “dual eligibles”. This plan has $0 premium and $0 co-pays for virtually all services except the small co-pays for prescription drugs.
The other plan options are primarily for “dual eligibles” – persons with Medicare and full scope Medi-Cal. If you are full dual, these plans have $0 premium and $0 co-pays for virtually all services. You may join these plans if you are not “dual eligible” but the plan will function like a high deductible plan. You will be responsible for standard Medicare deductibles and coinsurance for most services until you have spent $6700 out of pocket in one year.
Click here for a detailed chart of the Medicare-Medi-Cal Plans.