What Medicare Advantage, Medi Gap, Employer, Individual & Medi Cal Plans is Cedar’s Sinai,
UCLA Health Care Partners – Optum, THIPA Torrance Memorial IPA, or Stanford In Network for?
Cedars
Medicare A & B & Medi Gap Plans
What Health Insurance is Accepted by Cedars Sinai
Cedar’s Sinai accepts Traditional or original Medicare (Part A and/or B), including Medicare supplement insurance (Medigap) plans, you will have coverage for care from Cedars-Sinai Medical Center, Marina Del Rey Hospital and many of our doctors.
Medicare Advantage (Part C) Cedars Sinai *
Medicare Advantage or a Medicare Health plan, is purchased from a private insurance company and typically organized like an HMO or PPO insurance plan.
Cedars-Sinai participates Plans Accepted in the following Medicare Health #Advantage plans:
- Cedars Sinai will participate in the following Medicare Advantage plans in 2025:
- Alignment Health Plan
- Alignment Health Advantage PPO (PPO)
- Anthem Blue Cross of California
- Anthem/Carelon Medicare Advantage 2 (HMO)
- Anthem/Carelon Chronic Care (HMP C‑SNP)
- Anthem/Carelon Premium Savings 2 (HMO)
- Anthem/Carelon Lung Care (HMO C‑SNP)
- Anthem/Carelon Kidney Care (HMO C‑SNP)
- Anthem/Carelon Medicare Advantage (HMO)
- Anthem Full Advantage Aligned (HMO D‑SNP)
- Anthem Dual Advantage (HMO D‑SNP)
- Blue Shield of California
- UnitedHealthcare
- SCAN
- If you enroll in a HMO plan, you must choose a primary care doctor in either the Cedars-Sinai Medical Group or Cedars-Sinai Health Associates and be referred to specialists within these groups.
- Please note not all physicians participate in Medicare Advantage plans. After you have narrowed down your coverage choice, if physician availability is important to you, please call the health plan to confirm specific physicians will be in the product you choose. If you enroll in an HMO plan, you will be required to select a primary care physician in Cedars-Sinai Medical Group or Cedars-Sinai Health Associates and be referred to specialists within the physician network.
- Email us [email protected] more information on how to enroll, premiums, co pays, benefits
We can help you enroll, no extra charge for our services.
Email us [email protected] to verify the plans or use the provider finders on our Blue Shield and Blue Cross pages For UHC Get more information , we can help you enroll, no additional charge.
Of course, with a Medi Gap plan, you can go to ANY MD or hospital that accepts Medicare. Double check here, by using the tool on your right.
Cedars Sinai Insurances Accepted for:
Below are the Links to our #web pages for Plans we can consult & enroll you in!
- Employer Plans? (Per Cedar’s Website)
- Aetna Employer Group Coverage
- Blue Cross – Anthem – Employer Plans
- Blue Shield – Employer Group
- California Choice – Multiple Companies ONE Bill
- Health Net
- Kaiser Permanente – New Enrollment – Administrative
- Oscar
- Sharp Health Plan
- SHOP – Covered CA for Small Business
- Sutter Employer Health Plans 2022
- United Health Plan UHC
- Individual Plans? (Per Cedar’s Website)
- Blue Shield PPO
- Oscar – NOT Covered CA – Circle Network
- Medi Cal? (Per Cedars’s Website)
- Our webpage on picking a Medi Cal HMO
- Care to financially needy patients LA Times 1.2.2020 *
- Medi Cal Managed Care Find a Provider
- Our webpage on picking a Medi Cal HMO
- Out of USA Plans? (Per Cedar’s Website)
UCLA
What Medicare Advantage Plan can I get that #UCLA will Accept?
UCLA Medical Center
UCLA’s Insurance’s Accepted webpage!
Medicare Advantage HMOs:
HMOs:
UCLA Health Medicare Advantage Principal Plan (HMO)
UCLA Health Medicare Advantage Prestige Plan (HMO)
UnitedHealthcare – AARP Medicare Advantage from UHC CA-37P (HMO-POS)
PPOs:
Anthem Medicare Advantage
UnitedHealthcare – AARP Medicare Advantage from UHC CA-0029 (PPO)
Individual & Family Plans UCLA Webpage
Blue Shield Exclusive PPO Provider Finder
Employer Group Plans
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- HMO insurance and POS insurance
- PPO insurance
- Aetna
- Anthem Blue Cross
- Blue Shield of California
- Centivo
- Cigna
- Oscar offers Oscar EPO – Circle – CHOICE Network for small businesses
- CIGNA + Oscar for Small Biz
- First Health
- Health Net of California
- Interplan (part of HealthSmart)
- MultiPlan
- UFCM Health System, Inc., doing business as California Foundation for Medical Care (CFMC)
- Prime Health Services
- Private Healthcare Systems (PHCS)
- TRICARE
- United Health care
- Please call the UCLA Health referral line at 310-825-2631 or your health plan for the latest updates on which insurance plan networks UCLA hospitals and physicians participate.
- ucla health.org/price-transparency
UCLA Health doctors and differences in accepted health insurance*
Certain UCLA Health doctors may not accept the same insurance plans that our hospitals do. (Find a provider at UCLA Health.)
Please call the UCLA Health referral line at 800-UCLA-MD1 (800-825-2631) for the latest updates on which insurance a particular doctor may accept.
Optum
Health Care Partners
Health Care Partners – #OPTUM Insurance Accepted
MAPD Medicare Advantage Plans
Accepted & Available from Steve Shorr Insurance
- Blue Shield Individual
- United Health Care Get more information
- See Optum Link above for plans that Steve Shorr Insurance doesn’t represent
Original Medicare Parts A – Hospital and B Doctor Visits and
Medicare Supplements – Medi Gap:
- Anthem Blue Cross
- Blue Shield
- United Health Care Get more information
- SCAN – Email us [email protected]
- Who is Optum and what is their relationship with UHC?
- optum.com/business/employers
- fierce health care.com/why-unitedhealth-sees-combined-powers-its-health-plan-optum-as-a-competitive-advantage
- health care financenews.com/secret-weapon-unitedhealths-optum-business-laying-waste-old-notions-about-how-payers-make-money
- beckers hospital review.com/optum-closing-clinics-laying-off-500
- Broker ONLY Tools
Under 65 Individual Accepted Plans
On Optum Website
Covered California Plans
Generally same network as Direct or Off Exchange
- Health Net Employer Pure Care
- Health Net 2022 Pure Care
- LA Care – Medi Cal & Covered CA
- (LA County Only) Contract confirmed for ALL of 2021 12/15/2020 broker bulletin.
Blue Cross HMO
LA County ONLY
If you have any questions about the specific Insurance Company above, please ask on their webpage, use link above to go there.
Our Web pages for Carriers – Companies
THIPA – Torrance Memorial
What Health Insurance, MAPD, Medi Gap Plans does
#THIPA Torrance Memorial IPA
take?
Accepted Health Plans – Torrance Memorial IPA
- Medicare Advantage Plans we represent
- THIPA Torrance Hospital Independent Physician Association THIPA.org
- SEARCH Find a Doctor THIPA.org
THIPA Flyers
Torrance Memorial IPA Brochure
- Primary Care Physicians Brochure
- Torrance Memorial – Find a Doctor
- tm physician network.org/tmpn/find-a-doctor/
- torrance memorial ipa.org/ipa/find-a-doctor/
-
For Medicare Advantage HMO provider directory list, visit TMIPA.org
For Medicare Advantage PPO directory visit Tmphysiciannetwork.org
- Torrance Memorial IPA Specialist
- Broker ONLY
- torrancememorialipa.org/broker-portal
COVID 19
- Our Webpage on Insurance Company Bulletins for COVID 19
Torrance Memorial.org Insurance Accepted
- Torrance Memorial Medical Center has again been recognized as a Best Hospital for 2019-20 for the 8th consecutive year, placing us in the top 3% in the state by U.S. News and World Report!
- BROKER ONLY Portal
MISC
#Stanford Health Care – Hospital takes these Insurance Plans
- stanford financial-assistance
- stanford health care.org/financial-assistance-policy
- Healthcare providers are prohibited by law from billing people with Medi-Cal for charges not covered by their insurance. LA Times
- Stanford Health Care-ValleyCare Named Among Best US Hospitals: US News The Pleasanton hospital, which is set to expand, was one of 58 California hospitals to rank nationally.
-
Providence – Insurance Accepted on their website
- Medicare Advantage
- United Health Care
- AARP Medicare Advantage Choice Plan 1 (PPO)
- AARP Medicare Advantage Choice Plan 2 (PPO)
- United Health Care
- Individual – Covered CA
#Scripps
- Health Insurance Accepted by Scripps
- Scripps accepts Medicare Parts A and B, and Medicare supplemental (Medigap) plans.*
- * Please verify with your supplemental plan that your coverage applies to any Medicare provider. There are rare instances when a supplemental plan restricts your benefit coverage to a limited provider network.
- Two Scripps Health groups are dropping Medicare Advantage plans in 2024
- Scripps Clinic and Scripps Coastal
- The revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide
- Let me check on MAPD PPO plans. YES!
- Guaranteed Issue to Medi Gap?
- SCAN’s Bulletin – Change PCP – Which Medical Group?
- Scripps doctor groups said to have ‘terminated’ Medicare Advantage contracts
- Only Medicare is Medicare…
- san diego union tribune.com/ucsd-scripps-sharp-earn-national-rankings-in-latest-u-s-news-best-hospitals-report
Provider Finders
#Find a Anthem Blue Cross
Doctor, Physician, Dentist Hospital and other Providers
- Network Map Individual & Family Plans
- What plans do major providers accept?
- Cedar’s Sinai,
- UCLA
- Health Care Partners – Optum,
- THIPA Torrance Memorial IPA
-
Blue Cross Removes UC Hospitals From EPO Health Plans
UC Davis Medical Center, UC San Francisco Medical Center and Children’s Hospital, along with Benioff Children’s Hospital in Oakland are no longer part of their Pathway EPO network as January 1, 2022 Learn More - Insure Me Kevin.com
- Clinical utilization management (UM) guidelines focus on selection criteria, length of stay, and location for generally accepted technologies or services.
- Anthem Blue Cross Provider List Definitions Individual Plans
- Enroll with Blue Cross Anthem
- VIDEOS
- What to do when you receive a doctor bill VIDEO
- VIDEO When you're looking for health insurance in California, consider the quality of care provided by Anthem Blue Cross. The Anthem team knows the needs of growing families and offers an array of plans that offer affordable coverage for members of all ages.
- VIDEO What do do when you get a doctor's bill
- Live Health ONLINE - Tele Med with therapist VIDEO
- SYDNEY Overview VIDEO
- In & Out of Network - What's a network? HN Video
- Steve helps you find PCP VIDEO
Blue Shield of California
Provider #Finder -
Dentists, Doctors & Hospitals
All Plans - Medicare Advantage, Employer Group, Under 65 - Covered CA
Find a doctor near you
VIDEOS
- Blue Shield Exclusive PPO Your new ppo * PPO Primary MD FAQ’s * has 50k+ doctors and 320 hospitals statewide, plus Blue Card benefits out of state & country. 2020 Agent Guide * Member Outreach Bulletin *
- Providence Issues 2024
- How to use the Finding a provider tool above VIDEO
- Understanding Your Plan pdf
- Nurse Help 24/7, Heal and Teladoc save on prescriptions ER vs. urgent care.
- Use your online account to review claims, copays or deductibles and take advantage of other member benefits.
- Explanatory VIDEOS on everything... from Blue Shield
- chcf.org/primary-care-matters * More readable summary * Health care systems with strong levels of primary care investment have better and more equitable health outcomes, lower care costs, and better care quality. We can build a healthier future for all Californians by focusing resources back to patients and their relationship with primary care providers.
- Medicare Advantage Provider Print Directories BROKER ONLY
- Email us [email protected] if you want a pdf print directory
- Enroll and get full details on our
- What do I have to do to see a specialist if I'm in an HMO or Medicare Advantage Plan?
- Generally, just ask your PCP Primary Doctor.
- Check your Evidence of Coverage for details. Email us, [email protected] if you want a copy of it.
- What if my PCP won't give a referral.
- Check the procedure in your Evidence of Coverage, email us and see our webpage on appeals & IMR Independent Medical Review.
- Generally, just ask your PCP Primary Doctor.
Find Medicare Doctors who accept assignment #MD
- Our Webpage on Medicare Assignment – Doctor Participating or Not?
- Compare Hospitals - Search Medicare.gov
- Medicare Guide to Choosing a Hospital Publication # 10181
- Hospital Readmission Penalty Look Up
- Long-Term Acute Care Hospital (LTACH) Clinical Guidelines - Oscar
- US News & World Report America's Best Hospitals
- UCLA #3
- Cedar's Sinai # 6
- UCSF San Francisco #9
- Stanford #12
How to go about #Picking a HMO or PPO Primary Care Physician PCP – MD
PPO members for all Covered CA plans and maybe all? plans will now have a central point of contact PCP – Primary Care Physician, in the health system for receiving long-term, comprehensive, coordinated care for most health needs. PPO members are able to switch PCPs at any time. There is no action for members to take. Blue Shield will provide additional details on this new feature in the coming weeks.
Members of non-grandfathered PPO plans will continue to have the freedom to choose specialists and other providers – without referrals inside or outside the network – as they do now.
- PPO Primary Care MD – member communication from Covered California
- HHS offering $1 million to strengthen link between primary care and health equity
FAQ’s
- What is a primary care physician?
- Why is it important to have a PCP?
- How did we select your PCP match?
- When will I receive information about the PCP that I was matched with?
- I’ve been matched with a PCP. Now what?
- What should I consider when evaluating my PCP?
- How do I change my PCP?
- I already have a doctor that I like. How do I know if my preferred PCP is part of my plan’s network?
- I can’t find my preferred PCP in the Exclusive PPO Network. What do I do now?
- Will my PCP appear on my ID card?
- What happens if I make a change to my PCP?
- How often can I change my PCP?
- Provider Finder
- Primary Care & PPO VIDEO
- Understanding your plan VIDEO
- chcf.org/primary-care-matters * More readable summary * Health care systems with strong levels of primary care investment have better and more equitable health outcomes, lower care costs, and better care quality. We can build a healthier future for all Californians by focusing resources back to patients and their relationship with primary care providers.
- 7 tips for choosing a primary care doctor UHC
- Cedar's Sinai Provider Finder
Explanations of what’s Covered in Medicare
#Medicare10050 and You 2025
Everything you want to know
- Steve's Video Seminar Introduction to Medicare & You
- 2025 Changes & Updates CA Health Care Advocates 78 page slide show pdf
- Clear View to Medicare Patient Advocate.org - 36 pages
***********
- Your Medicare #Benefits # 10116
- Inpatient ONLY - How Medicare Pays for your Surgery Part A vs Part B Very Well Health.com
- medicare.gov/coverage
- What's Covered App for Smartphones
- Medicare Coverage Database Search
- medicare.gov/procedure-price-lookup
- MLN Items & Services Not Covered Under Medicare
- An Overview-05-19-23 CA Health Care Advocates Hi Cap
- Original Medicare: An Overview CA Health Care Advocates Hi Cap
- 2024 Premiums, Coinsurance & Deductibles – 10-19-23 CA Health Care Advocates Hi Cap
- Supplementing Medicare: An Overview 10-30-20 CA Health Care Advocates Hi Cap
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- SCAN
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- #Intake Form - We can better prepare for the meeting (National Contracting Center)
- TITLE XVIII—HEALTH INSURANCE FOR THE AGED - Medicare AND DISABLE
-
- Welcome to Medicare 2022 Publication # 11095
- Our webpage on Enrolling ONLINE for Medicare Part A Hospital & B Doctor Visits
- Part A Hospital rules for zero premium
- Part B – Doctors – How to sign up – Benefits
- How to apply for Part B when you lose employer coverage - during your special enrollment period # 10012
- Fact Sheet Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 CMS.gov 15 pages
- Medicare & You: Deciding to Sign Up for Medicare Part B VIDEO
- CMS form to fill out L 564 E to prove you had Employer Coverage and get a special enrollment period, when you retire. VIDEO
- HI CAP CA Health Care Advocates Medicare Enrollment Periods
FAQ's from Medicare.Gov
#Should I get Parts A & B?
Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases, #How
It depends on the type of health coverage you may have.
- Deciding to Sign Up for Medicare Part B VIDEO
- You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
- If I'm low income - are there any breaks?
- Interactive Q & A from IRS on when to sign up for Medicare
- I have coverage through my spouse who is currently working.
- I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
- I have TRICARE, and I'm a retired service member.
- I have TRICARE, and I'm an active-duty service member.
- I have CHAMPVA.
- I have End-Stage Renal Disease (ESRD).
- I have Marketplace Covered CA or other private insurance.
- I don't have any of these.
- medicare.gov/should-i-get-parts-a-b
- How to apply for Part B during your special enrollment period # 10012
- Fact Sheet Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 15 pages
- FAQ's that we did
Blue Shield of California Authorized Agent - Broker
Medi Gap Plans from Anthem Blue Cross –
Click for Information and ONLINE enrollment
#Understanding Medicare Advantage Plans (PDF) #12026
- MAPD Plans look like a great deal, as the "premium" is paid by fee from the Federal Government, on average $2k/year.Kff * MAPD Plans must cover all A & B services Medicare.Gov * generally they also cover Part D Rx.
- That's why the premium is very low or ZERO!
- Set a Zoom Meeting
- We can now do SOC Scope of Appointment, before the Meeting via a 3 minute recorded meeting 2 days before. AHIP Training Module 4 Page 14 *
- #Intake Form Berwick Needs Assessment Form - We can better prepare for the meeting
- Medicare Advantage (Medicare Part C): An Overview Hi Cap
- HMO - Narrow Networks?
- HI Cap CA Health Care Advocates Fact Sheet
- Do I just sign up with a Medicare Advantage Company and automatically get * Parts A & B or do I have to get those from Medicare.Gov * VIDEO
- Get Quotes, Full Information and Enroll
- MANDATED wording!: Think Advisor * ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
- FYI a 4.27.2022 HHS Office of the Inspector General report found that MAPD plans denied 13% of prior authorizations that would have been covered under original Medicare (Conversely, Medi Gap, just follows what Medicare pays.)
- 88% of MAPD enrollees are happy
-
MAPD plans often include Dental & Part D - Rx Prescriptions and often have NO premiums!
-
How is that possible?
-
The Federal Government pays them around $700/month to handle your medical care. You must continue to pay your Medicare Part B premium of about $170/month. It's best to apply when you turn 65 for the supplement plans or advantage plans, as that's the main "Open Enrollment" period, guaranteed issue for any plan.
-
-
-
Medicare Advantage Plans also have an annual open enrollment now known as AEP Annual Election Period October 7 to December 15th.
-
Additional Coverage is important as Medical Bills are increasing Seniors Credit Card Debt or leading to possible bankruptcy?
- If You Have Problems with Your Medicare Advantage Plan
- forbes.com/how-insurers-can-navigate-the-costs-of-medicare-advantage-benefits
- politico.com/medicare-advantage-plans-congress
- Uncle Sam wants you to help stop insurers' bogus Medicare Advantage sales tactics
- ca health advocates/using-ai-to-deny-care
- Dodging the Medicare Enrollment Deadline Can Be Costly
- Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals and Doctors
- Medicare Advantage is bad for patients and bad for investors
- When Medicare Advantage Plans Terminate Coverage
- Medi-Cal D-SNP Feasibility Study
I just was informed that my Health Net insurance coverage issued by Los Angeles Unified School District will not enable me to continue with the Cedars Sinai Medical Associates that I’ve been covered under.
Do you know if there is a way to continue this coverage using Anthem Blue Cross HMO or EPO with some type of supplemental insurance coverage that isn’t prohibitive cost wise?
Here’s information we have for CalSTRS and LAUSD Retirement Plans.
Blue Cross HMO & EPO are other options one can pick from on LAUSD Open Enrollment.
One would need to double check that Cedars Sinai is covered by those plans. You’ll find Blue Cross’s Provider Finder on my webpage here.
The first, initial response from LAUSD is that you can only change if you have a Major Life Event, due to IRS rules.
Major Life Events/Actions
• Begins/ends full-time employment
• Begins retirement
• Marriage, divorce or death of a spouse
• Birth or adoption
• Death of a covered child
• Spouse gains/or loses employer health plan eligibility
• Spouse loses employment
• Gains/loses eligibility for Medicare
• Employee/retiree or dependent moves in or out of plan’s service area
We might look into if you could qualify under SB 133 AB 369 Continuity of Care? Are you being treated for a chronic, acute or terminal illness? You may answer privately – email us at [email protected] or just reply below and don’t put in your name.
This might also qualify as a special enrollment into an individual plan? Group Plans might have something similar, I’d have to research.
Here’s the contact page for LAUSD benefits administration.