| Dear SAL, In September I will turn 65 and I need to make decisions about health care insurance. The more I read on the internet, the more confused I get. In my research I have encountered Medicare, Medi-Cal, Medicaid, Medigap, Medicare Advantage and Medicare Savings Programs. Can you help me make sense of all this? -Having Healthcare Headaches It's perfectly understandable that you are confused. Take heart, help is on the way for your headaches! The good news is that there is a service available to walk you through your options. Free counseling, advocacy, and advice is available through the Health Insurance Counseling Advocacy Program (HICAP). These services are mandated by federal and state laws. Counselors do not sell or promote any insurance products. In Nevada County, you can call the Retired Senior Volunteer Program (RSVP) at 530-271-0255 to set up an appointment with a HICAP counselor. This is a great way to get answers and advice personalized to your particular needs and wishes. For those who prefer to delve into the information themselves, here is a brief overview of the programs you mentioned: Medicare is a nationwide, federally financed health insurance plan for those 65 and older, people with disabilities who are eligible for Social Security disability benefits and people on dialysis for chronic kidney disease. It is the major health insurance used by seniors and has been in effect since 1965. Under Medicare, the costs for health care services are billed to the government.
Because Medicare does not fully cover health care costs,
Medigap insurance is additional coverage you can buy from a private insurance company to fill in the gaps in original fee-for-service Medicare coverage by paying for your Medicare deductibles, coinsurances and copayments. A Medigap policy covers expenses approved by Medicare but excluded from Medicare's payment. These policies also offer some additional coverage for items Medicare excludes.
Premiums vary, depending on the plan you choose and the company you buy it from.
Medicare Advantage, also known as Senior Advantage, was added to Medicare coverage options to give seniors a choice of how they wanted their coverage provided. Seniors may select fee-for-service Medicare or assign their coverage to an alternate plan. Medicare Advantage plans are usually managed care plans, such as HMOs and PPOs.
Someone with fee-for-service Medicare very likely also will have a
Medigap policy and may qualify for Medi-Cal. A person with an HMO or PPO would not need a Medigap policy but may qualify for Medi-Cal. Those with Medicare and Medi-Cal are called dual-eligible, previously called Medi-Medi.
Medi-Cal is California's version of Medicaid, a federal health care assistance program designed to help pay medical expenses for individuals and families with low-income.
Medi-Cal is jointly funded by the federal government and the state of California. Each state designs and administers its own program, and it is managed at the county level. To be eligible for Medi-Cal, applicants must meet residency, age, or disability requirements and show financial need. 211 Nevada County can provide basic Medi-Cal eligibility screening and refer you to resources to assist with the application process. If you do not qualify for Medi-Cal but still have problems paying for health care, you may qualify for Medicare Savings Programs, government programs that help pay your Medicare costs. This is a simplified explanation of complicated health care insurance options. For more information, go to the Medicare website. |
The Area 4 Agency on Aging wants to hear from older adults! A4AA is currently conducting a survey of seniors to help set priorities for how state and federal funds are distributed. This is your chance to give feedback on the types of programs and services available for older adults and their families.
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