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Are you New to Medicare? 

Learn about how to enroll in Part A Hospital and Part B Doctor Visits and then follow the link to Medicare’s site where you can enroll.  We are happy to help you enroll and there is no extra charge when you get plans  supplement Medicare, like Medi Gap, Part D Rx and Medicare Advantage.

We will try to give you everything you want to know in Plain English.  Medicare might be very confusing.  IMHO, if one just takes some patience and reviews the information and brochures, both from us and from Official Medicare Pamphlets, it should get clear.  If not, email us, * set a meeting, * ask us a question right on our website, you don’t have to even leave your name.

We highly recommend that you at least glance through   Medicare & You Publication # 10050 which  gives an EXCELLENT Overview and most of the Information you will ever want to know. 

If you are viewing this webpage on a full screen monitor, we show many of the Medicare Brochures to the right, if you are viewing on a smartphone, just scroll down.

VIDEO Seminar - Introduction to #MediGap

by Steve

Medi Gap Introductory Video

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.  MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

#MedicareRelated Pages

You cannot buy additional coverage through #Covered California
if you have premium-free Medicare Part A Hospital

 

Medicare complies with Health Care Reform, so you do NOT need to get a an Individual policy or a subsidized one from Covered CA.  It fact, it's illegal for anyone to sell you a policy!  Kaiser Health News * Covered CA Medicare Fact Sheet * Medicare.Gov Medicare & Market Place #11694  * CMS.Gov FAQ Medicare & Marketplace * HealthCare.Gov when - how to change from Covered CA to Medicare  * Social Security §1882  * Health Care.Gov

NOTE: This information also applies to people younger than 65 whose benefits begin the first month they receive disability benefits because they have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s Disease, and to people younger than 65 who have Medicare because of a disability and are receiving SSDI Social Security Disability Insurance.

 

There are a lot of ands, if or buts in this complex issue.  Please refer to the source material below.  There are some exceptions, but they are very complex.  Don't even think of getting a 1/2 correct answer over the phone. If you have to pay for Part A Hospital, then are options, like subsided Covered CA Plans. Email us [email protected] or ask a question below.

Video about Covered CA – if no Premium Free Part A – jump to 2:30  Medicare & the Marketplace (Covered CA

Links & Resources 

Sec. 1882. [42 U.S.C. 1395ss]

(3)(A)

(i) It is unlawful for a person to sell or issue to an individual entitled [no premium] to benefits under part A or enrolled under part B of this title (including an individual electing a Medicare+Choice plan [MAPD] under section 1851)—

(I) a health insurance policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under this title or title XIX,

(II) in the case of an individual not electing a Medicare+Choice plan, [aka MAPD Medicare Advantage] a medicare supplemental policy with knowledge that the individual is entitled to benefits under another medicare supplemental policy or in the case of an individual electing a Medicare+Choice plan, a medicare supplemental policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under the Medicare+Choice plan or under another medicare supplemental policy, or

(III) a health insurance policy (other than a medicare supplemental policy) with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of State or Federal law.

(ii) Whoever violates clause (i) shall be fined under title 18, United States Code, or imprisoned not more than 5 years, or both, and, in addition to or in lieu of such a criminal penalty, is subject to a civil money penalty of not to exceed $25,000 (or $15,000 in the case of a person other than the issuer of the policy) for each such prohibited act. Sec. 1882. [42 U.S.C. 1395ss] 

 

Our webpages that touch on this Issue:

History of Medicare 
on  cms.gov

cms.gov/History cms.gov/KeyMilestones.pdf

govbooktalk.gpo.govhappy-birthday-medicare/

Video History of Medicare

 Consumer Resources & Links

Set a personal Consultation Time

10 comments on “Medicare – Introduction – Part A Hospital – B Outpatient – D Rx Medi Gap & MAPD

  1. Wed, 24 Dec 2008

    Steve,

    I was looking for some specific Medicare information and found your site on Google.

    You have a great site. It is very informative without a lot of meaningless information.

    I thought I’d tell you that. I think I am glad you are not in my area. I’d hate to have you as a competitor.

    Best regards,

    Mark A. Squires.
    Principal
    Squires. and Associates
    Independence MO

    • Generally no, it’s automatic renewal.

      I presume you are talking about a Medicare Advantage plan. Yes, there are warnings all over the “typical” Summary of Benefits that Medicare must renew the contract with the insurance company for your plan to renew.

      Did you get an ANOC – Annual Notice of Change or cancellation notice?

      What should I do if I get this notice?

      Review any changes to decide whether the plan will continue to meet your needs in the next year.
      If you don’t get this important document, contact your plan.

      If you send us privately [email protected] your current ID card or other documentation to verify your current coverage, we can see what your renewal terms are.

  2. I’m not a happy camper with Kaiser MAPD….

    Yeah, but the care is poor and designed for cost savings at the patient’s expense. Here are our real life examples:

    Kaiser: loaner CPAP machine and get a personal CPAP
    Outside: overnight sleep study at a clinic covered in-network to properly diagnose the true extent of sleep apnea. Get CPAP.

    Kaiser: thyroid is on the low side of normal, but it doesn’t feel right. Kaiser PCP thinks all is OK.
    Outside: Armour thyroid treatment (Kaiser won’t prescribe this) in-network

    Kaiser: 2 months or more to get a psychiatry appointment and therapist. Only once every 2-3 months for both.
    Outside: Use a PPO to find an out-of-network psychiatrist that can take an appointment this week Same for therapist.

    ER doc: Shaking in the hands. Why aren’t you seeing a neurologist? You need to start seeing a doctor rather than come to the ER.

    Patient: But I have a Kaiser neurologist that I have for years and I saw last week and he has been unsuccessful at treatment.

    Kaiser: Thinks granny is a drug seeker. Granny has “medieval Game of Thrones torture” 12 out of 10 pain. Unable to get PCP to take her seriously.
    Actual: Unrelated surgeon found a huge sack of pus in the hip that has destroyed her hip joint and it was the source of her pain.

    Granny is on 25 concurrent prescription medications. I found that a good time saving way to push patients out the door is to prescribe meds. Granny doesn’t have the mental ability to question the wisdom of being on 25 meds concurrently or risk getting an opiate addiction.

    If you have easy to diagnose diseases, Kaiser works OK and it’s very convenient. It actually works fine for myself if I didn’t know any better.

    For members of my family who have difficult to treat diseases, it’s pretty piss poor. You don’t want to be sick and on Kaiser. It’s like choosing convenient McDonalds vs. a dinner service only steakhouse. McDonald’s rushes to serve you food within 2 minutes and it is edible. It’s also open 24 hours. It’s also very low cost. Steak place might be unaffordable especially if government is paying for a huge part of the bill.There you go, McD should get five stars even though it’s processed food crap because the crap is edible. In Norcal, Senior Advantage is very expensive with high copays and premiums. Why not just prepay with premiums on plan A/B/D/F, get no copays other than rx, and then choose the doctor of your choice that you can easily fire. You can’t fire a specialist at Kaiser without a ton of social engineering.

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