Plans at a Glance
- Enrollment Kit -- Summary of Benefits Rev 7.2021 Plan G Be sure to return the application to us or see link above to enroll online
- July 2021 Rates Los Angeles Scroll down for other counties
- No tobacco surcharge if you are applying during a guaranteed issue period, like turning 65 or lucking out and there is a Underwriting Holiday
- Going Forward ONLY ONE rate change per year!
- Ways to pay premium See page 42 of Summary of Benefits
- Don't like Rate Charts - Get Medi Gap quotes here
- Rate increases & rebates are subject to MLR Medical Loss ratio rules
- Rates go up by age, CA does not have community rating or issue age FAQ
- July 2021 Rates Los Angeles Scroll down for other counties
- Paper Application 2021 but online is better
- No extra charge for us to assist you! 17 reasons why...
A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage.
If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plans – Part C (like an HMO or PPO) because those plans are ways to get Medicare benefits, (here’s a comparison of the differences) while a Medigap policy only supplements the costs of your Original Medicare benefits. Medicare.Gov Guide to Medigap *
Medicare Part A Hospital coverage helps pay for care in hospitals as an inpatient,... skilled nursing facilities, hospice care, and some home health care (see publication # 10969) but not Long Term Care.
Most people get Part A automatically when they turn age 65 at no charge, since they or a spouse paid Medicare taxes while they were working. You need to sign up close to your 65th birthday, even if you will not be retired by that time. (If you are getting Social Security benefits when you turn 65, your Medicare Hospital Benefits - Part A - start automatically.)
Here's a chart it's just a illustration and is NOT official that shows what Medicare pays, the gaps in Medicare and what you may get when you add a Medi Gap Plan or Medicare Advantage to cover those gaps.
Part B - Outpatient helps Pay For Doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care see publication 10969, but not Long Term Care. Part B helps pay for these covered services and supplies when they are medically necessary.
Our Webpages with more detail:
- Coverage in Part A Hospital & B Doctor Visits? Part D Rx
- Chiropractic – Medicare A & B – MAPD
- Diabetes – Prevention & Coverage under Medicare & ACA
- Durable Medical Equipment
- End Stage Renal – Kidney Failure
- Hearing Aids
- Physical therapy – occupational speech
- Skilled Nursing SNF & Home Health What Medicare Pays
- Togetherness – Loneliness Social Determinants of Health
- Mental Health
- How to sign up for Medicare?
- FAQ Medical Necessity our Medical Necessity Webpage
- 2021 Official Medicare Guide to choosing a Medi Gap Policy # 02110
- Anthem Blue Cross Information & Enrollment
- United Health Care
- Blue Shield – Medi-Gap Information & Enrollment
- Your Rights to Enroll without Health Questions
Care Compare Video
Care Compare on Medicare.gov is a streamlined redesign of the 8 Medicare.gov compare tools.
Medicare Video - Physician Compare
Our Webpage on What is it when your doctor Medicare agrees to Assignment?
- Hospital Readmission Penalty Look Up
- Long-Term Acute Care Hospital (LTACH) Clinical Guidelines - Oscar
- US News & World Report America's Best Hospitals
Dental PPO Plan and Dental + Vision brochure and enrollment application
EOC Evidence of Coverage
Evidence of Coverage
2022 Open Plans
Evidences of Coverage for 2010 Standardized Closed Plans (closed 9/30/2019)
Evidences of Coverage for Standardized and Pre-Standardized Closed Plans (closed prior to 5/31/2010)
Get complete descriptions of our closed Medicare Supplement plans.
Plan A (pre June 2010) (PDF)
Plan B (pre June 2010) (PDF)
Plan C (pre June 2010) (PDF)
Plan D (pre June 2010) (PDF)
Plan F (pre June 2010) (PDF)
Plan G (pre June 2010) (PDF)
Plan J (pre June 2010) (PDF)
Plan K (pre June 2010) (PDF)
Plan H Standard (PDF)
Plan H Plus Rx (PDF)
Plan I Standard (PDF)
Plan I Plus Rx (PDF)
Coronet Major Medicare (PDF)
Coronet Senior Standard (PDF)
Coronet Senior Plus Rx (PDF)
Golden Coronet Senior Standard (PDF)
Golden Coronet Senior Plus Rx (PDF)
Preferred Senior (PDF)
Closed plan rate sheets
Resources & Links
Member Services 800.766.4466
- Medicare Provider Finder (Any MD that takes Medicare works on this plan)
- Blue Shield guaranteed.acceptance.guide.
- Silver Sneakers.com
- Blue Shield CA .com – Explanation
- Blue Shield Financial Strength
- Medicare Supplement Plan Transfer Application – be sure to put in our name as agent and email [email protected] to us
Blue Shield Videos On Medicare
“Medicare Enlightenment” video series out now!
- Medicare Enlightenment – Entire Video 18 minutes
- Different Parts of Medicare
- Original Medicare Parts A& B: What’s Not Covered
- When can I enroll in Medicare
- Your Medicare Coverage Choices at a Glance
- Medicare Advantage Plans – Part C
- Medicare Supplement Plans
- Prescription Drug Plans
Blue Shield Medi Gap Forms
Email [email protected] or call us 310.519.1335
Our #High Income Surcharge Video Explanation
- Premiums for those with High Income Parts D Rx & B Doctor Visits
- Kaiser Foundation Introduction - Overview
- Medicare Rx Benefit Manual Rev 1.2016 83 pages
- Network Pharmacies, Formularies & Common Coverage Rules # 11136
- Insulin Maximum Co Pay $35
- Rx covered under Part B
- Graphic on Part D Premium Increases & Why?
- Maximus Appeals LEP Late Enrollment Penalty
- VIDEO How Part D Late Enrollment Penalty is calculated
- Shop & Compare Tools Part D Rx
- Get Instant Quotes, Information & Enroll online
Child & Related Pages – Site Map
References, Links & Bibliography
- SNF Skilled Nursing Medicare.Gov
- Medicare.Gov Glossary
- Benefit Period
- CMS on Benefits Periods Official Detailed Manual
- Medicare Rights.org
- Medicare Interactive
Benefit periods measure your use of inpatient hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your deductible, Original Medicare pays in full for days 1 to 60 that you are in a hospital. For days 61-90, you pay a daily coinsurance.
If you have used your 90 days of hospital coverage but need to stay longer, Medicare covers up to 60 additional lifetime reserve days, for which you will pay a daily coinsurance. These days are nonrenewable, meaning you will not get them back when you become eligible for another benefit period.
Medicare will stop paying for your inpatient-related hospital costs (such as room and board) if you run out of days during your benefit period. To be eligible for a new benefit period, and additional days of inpatient coverage, you must remain out of the hospital or SNF for 60 days in a row. When you start a new benefit period, you will also have a new Part A deductible.
Note: Medigap policies A through N pay for your hospital coinsurance and provide up to an additional 365 lifetime reserve days. Additionally, Plans B through N pay some or all of your hospital deductible. Medicare Interactive
- Skilled Nursing over 100 days
- SNF Skilled Nursing past 100 days Medicare Interactive
- Lifetime Reserve Days
- Medicare Interactive from Medicare
- Additional 365 from Medi Gap – EOC Page 4 II A 1 c
- c) Upon exhaustion of the Medicare hospital inpatient coverage including the sixty (60) lifetime reserve days, coverage for the Medicare Part A Eligible Expenses for hospitalization will be paid at the appropriate standard of payment which has been approved by Medicare, subject to a lifetime maximum benefit of an additional 365 days (except that psychiatric care in a psychiatric hospital participating in the Medicare program is limited to 190 days during the Subscriber’s lifetime);
CA Insurance Code (b) With respect to the standards for basic (core) benefits for benefit plans A to J, inclusive, every issuer shall make available a policy or certificate including only the following basic “core” package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare supplement insurance benefit plans in addition to the basic core package, but not in lieu of it. However, the benefits described in paragraphs (6) and (7) shall not be offered so long as California is required to disallow these benefits for Medicare beneficiaries by the Centers for Medicare and Medicaid Services or other agent of the federal government under Section 1395ss of Title 42 of the United States Code.
(1) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day to the 90th day, inclusive, in any Medicare benefit period.
(2) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used.
(3) Upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer’s payment as payment in full and may not bill the insured for any balance.
- (c) The following additional benefits shall be included in Medicare supplement benefit plans B to J, inclusive, only as provided by Section 10192.9.
(2) With respect to skilled nursing facility care, coverage for the actual billed charges up to the coinsurance amount from the 21st day to the 100th day, inclusive, in a Medicare benefit period for post hospital skilled nursing facility care eligible under Medicare Part A. CA Insurance Code 10192.8 b
- Law & Legal Codes
- CA Law on Medi Gap Policies
- Medicare General Information, Eligibility, and Entitlement