Blue Shield Medi-Gap – Supplement Plans
These plans allow you to go to ANY Doctor or Hospital that accepts Medicare
| Enroll ONLINE | Skilled Nursing Home Health | FAQ’s Ask us a question | Compare Plans G vs all others A – N Chart |
Plans at a Glance
rev 7.2021
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- 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
- Plan Transfer Application Be sure to add our agent # 8914 or NAIC National Producer # 2710578 so that we can credit for helping you Hints to complete the plan transfer application
- Medicare Advantage & Part D Rx enrollment periods - they don't necessarily coincide with Medi Gap!
- No extra charge for us to assist you! 17 reasons why...
- Already enrolled? Appoint us as your broker. No extra charge
- FAQ on comparing options
- Extra benefits in the "Extra Plans"
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 Insurance)
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.
The chart below is a very brief summary. Check the actual Evidence of Coverage for the plan you want to enroll in, Medicare & You or actual Medicare documents.
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
Care Compare Video
Care Compare on Medicare.gov is a streamlined redesign of the 8 Medicare.gov compare tools.
Medicare Video - Physician Compare
Video on how to use Medicare Provider Finder
Our Webpage on What is it when your doctor Medicare agrees to Assignment?
Guide to Choosing a Hospital # 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
Steve talks about Plan G & Extra - Innovative VIDEO
What Plan G pays in addition to Medicare Parts A & B
- Check our Carrier Pages for the latest Info
Dental PPO Plan and Dental + Vision brochure and enrollment application
- Brochure and enrollment application, English 7.2021
Dental/Duo Disclosures
EOC Evidence of Coverage
Dental PPO 1000 Rev 2022
Dental PPO 1500 Rev 2022
Specialty Duo Dental Policy* Rev 2018
Specialty Duo Vision Policy* Rev 2021
Evidence of Coverage
2022 Open Plans
Plan A (PDF, 231 KB)
Plan F Extra* (PDF, 292 KB)
Plan G (PDF, 237 KB)
Plan G Extra (PDF, 294 KB)
Plan G Inspire (PDF, 287 KB)
Plan N (PDF, 240 KB)
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Plan A, Jan. 2018 (PDF)
Plan F Extra, Oct. 2018 (PDF)
Plan G, Jan. 2018 (PDF)
Plan G Extra, Jan. 2020 (PDF)
Plan N, Jan. 2018 (PDF)
Evidences of Coverage for 2010 Standardized Closed Plans (closed 9/30/2019)
Plan C, Jan. 2018 (PDF)
Plan D, Jan. 2018 (PDF)
Plan F, Jan. 2018 (PDF)
High Deductible Plan F, Jan. 2019 (PDF)
Plan K, Jan. 2019 (PDF)
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
2010 Standardized Closed Plans (closed 5/31/2010) (PDF)
1990 Standardized Closed Plans (closed 5/31/2010) (PDF)
1990 Standardized Closed Plans (closed 12/31/2005) (PDF)
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
- Our Blue Shield Web Pages on Medicare
- Blue Shield 65 Plus – Inspire HMO 2021
- Blue Shield – Medi-Gap – Any Medicare Provider
Blue Shield Medi Gap Forms
Medicare Supplement Plan Transfer Application – Helpful tips, be sure to put in our name as agent and email to us Appoint us as your Broker – No Extra Charge
Medi Gap Plan Replacement Form
Email [email protected] or call us 310.519.1335
Prescription Drug #RxGuide
PDF # 11109
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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
How does Medi Gap Plan Hi F pay for Hospital Care, Long Term #Acute Hospital, Skilled Nursing, Home Health Care?
What happens if you go over 90 days? How do 60 lifetime reserve days work? How do 365 additional from Medi Gap work?
Email us [email protected] for Source Brochure
References, Links & Bibliography
- Coverage
- SNF Skilled Nursing Medicare.Gov
- Definitions
- Medicare.Gov Glossary
- Benefit Period
- CMS on Benefits Periods Official Detailed Manual
- Medicare Rights.org
- Medicare Interactive
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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
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- 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);
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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.
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(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.
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- (c) The following additional benefits shall be included in Medicare supplement benefit plans B to J, inclusive, only as provided by Section 10192.9.
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(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
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- Law & Legal Codes
- CA Law on Medi Gap Policies
- Medicare General Information, Eligibility, and Entitlement
4 comments on “FAQ’s non conical”
I think it’s fairly simple — if you want the most coverage, you get A, B, D + F.. Am I correct?
Depends what you mean by “most.” Part A covers hospital. Part B doctor visits. Learn More Part D covers outpatient prescriptions, rx. Plan F pays the co pays and deductibles in A & B. See the comparison below and note that the standard F doesn’t have the $2,240 deductible.
Some would say “most” might be a Medicare Advantage plan, in that the premiums are usually nil. One downside is the limited HMO doctor list Medicare Advantage MAPD may also cover vision and dental. Check our Medicare Advantage pages to learn more. Here’s our page on comparing Medi Gap vs MAPD. Medi Gap though gives you MUCH more freedom of choice of doctors.
I’m thinking of getting Hi F, with the $2,240 deductible. How do I know if that’s the right plan for me?
We’ve discussed similar questions here.
There is no FREE LUNCH when you buy Insurance. The Insurance Companies are in business to make a profit. Either way, the Insurance Company has calculated that they will pay out 80 cents on each dollar of premium they take in.
Check out the sample rates below from the Blue Shield Medi Gap Brochure
Does saving around $120/month or $1,400/year make it worth it to get back $2,200 if you have that many claims? Why not get Long Term Care, where the stakes are higher and there is the potential for real loss and hardship. The difference between F and Hi F is $800. I don’t think that will bankrupt anyone.
If I don’t have a Medi Gap plan, how much would I pay for an angio gram?
This website says a Fair Price is $3k https://www.newchoicehealth.com/places/california/los-angeles/ct-scan/ct-angiography-chest
Medicare might discount that…
So you would pay 20% or $600
I have Medi Gap Plan F Extra and Blue Shield Rx Plus for Part D
I don’t know if I should keep what I have or if there are better options.
First of, we can lose our license to sell Medicare Advantage plans, if say “this is the best plan.” https://medicare.healthreformquotes.com/mapd/regulations/best-plan/
So, watch this video and follow the links and we’ll look at the options and the pros and cons.
https://steveshorr.com/intro/set-a-meeting/
Summary of benefits Matrix
Rate Chart Medi Gap
https://medicare.healthreformquotes.com/part-d-rx/blue-cross/
https://medicare.healthreformquotes.com/mapd/65-plus
https://medicare.healthreformquotes.com/part-d-rx/blue-shield/
I’m having medically necessary treatment for varicose veins.
How much would Medicare pay?
How much would a Medi Gap plan pay?
First, we need to find out what the procedure costs, retail.
Then what Medicare allows.
What the billing codes are.
Is the procedure really medically necessary? https://individuals.healthreformquotes.com/appeal-grievances/medical-necessity/
FYI Clinical Bulletin for Varicose Veins https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_TX_Varicose_Venous_Insufficiency.pdf
Vein stripping and ligation takes about 60 to 90 minutes to perform and sometimes requires general anesthesia. Recovery time is also lengthy, usually involving two to four weeks depending on how many veins were stripped and where they were located.
Vein stripping surgery costs between $1,500 and $3,000. This cost may not include additional fees charged by the hospital or surgical center, which can increase the cost exponentially.
Another varicose vein-removing surgery is called ambulatory phlebectomy. During this procedure, your doctor makes tiny cuts in the skin to remove small varicose veins; usually those that are closest to the surface. The in-office procedure is done with local anesthesia and is considered much less invasive than vein stripping and ligation.
Ambulatory phlebectomy may cost between $1,000 and $3,000 per leg depending on the extent and number of veins removed. https://www.yourplasticsurgeryguide.com/other-procedures/varicose-vein/
Medicare does cover the medical treatment of varicose veins that cause symptoms and have ultrasound characteristics of chronic venous insufficiency. https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
A physician office visit and diagnostic ultrasound are needed to determine the medical necessity of vein treatments. Patients are encouraged to try non-medical treatment options such as exercise, weight-loss, and compression stockings (20-30mmHg) prior to medical vein procedures. As varicose vein symptoms become more severe, the likelihood that Medicare will cover the cost of treatment increases dramatically. https://vanishlegveins.com/does-medicare-cover-varicose-vein-treatments/
ICD Codes angiodynamics.com/img/documents/2020-Venacure-EVLT-Reimbursement-Guide-USVIMS17Rev01-276375.pdf
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics-Items/0145-Endovenous-Radiofrequency-Ablation-ERFA-and-Endovenous-Laser-Treatment-EVLT-for-Lower-Extremity-Varicose-Vein
Sorry, but this question is really beyond my pay grade.
President Obama on when human rights begin..https://www.youtube.com/watch?v=cOTfnz11kBk
Do you know if there will be any increases on our current Blue Shield supplemental plan [Hi F] next year?
See our other page with FAQ’s on Hi F rate changes
Medi Gap rate and benefit changes do not coincide with Part D Rx or Medicare Advantage AEP of October 15th through December 7th with an effective date of January 1st.
The rates change when Blue Shield “gets to it.” Traditionally it seems in April. Here’s an older rate chart. The main change in rates would be getting older, as opposed to rate changes, inflation or Medical Loss Ratio.
Here’s what seems to be the most current rate chart
One can get quotes here
I have Plan N and would like to get an Issue Age plan, rather than having the rates go up every year, based on attained age. Are those plans available in CA?
Gosh, the only time I come across the terms “issue age” or “attained age” is when doing Continuing Education classes or reading official government brochures, like the Guide to choosing a Medi Gap Policy
I’m not aware of any issue or entry age plans in CA where the rates don’t increase because of age. Here’s our quote engine for the plans we do offer in CA.
More detail from CA Health Care Advocates
https://cahealthadvocates.org/medigap/medigap-premiums/
Our webpage on Community Rating – which as far as I know, isn’t in CA either.
State of CA Department of Insurance Comparison Tool
https://interactive.web.insurance.ca.gov/apex_extprd/f?p=111:31:::NO:::
ALL plans are attained Age!
Methodology: AA
http://www.insurance.ca.gov/01-consumers/105-type/9-compare-prem/long-term-care-rate-methodology.cfm
We’re in Plan F now.
What’s the difference between F and G extra?
We tried to get F Extra and were turned down
Please review our webpage above and our webpage on Plan F Extra. The main difference in Extra or Innovative is the Hearing Aids, Vision, Teledoc, Over the Counter Medications and Help, I can’t get up. See the link above for the summary of benefits for more detail.
Right now, Blue Shield is having a “special” and you can get into their Extra Plans, from any other Medi Gap carrier. Email us for details.
Next year, under the Birthday rule, Extra and Innovative will be considered the same and not better. So, one would be able to switch.
Why are Medi Gap companies offered more benefits?
One reason is a new buzz word, Social Determinants of Health. Click on the link and check it out.
My wife is disabled with a brain tumor. She has plan High F. She collects SSDI and qualified for Medicare after two years of disability. She is also on Medi Cal.
We currently pay $412.30 for Part F and the Duo Package (dental and vision), plus $86.40 for the PDP.
Any suggestions?
Please let us know what of 7 qualifications QMB etc. you have for Medi-Cal.
How are you dealing with the rules of
dual coverage Medicare &
dual coverage Medi Cal and
dual coverage in general?
Are you using Medi Cal MD’s?
Are you paying the Hi F deductible $2,340? or is that getting reimbursed?
Who is paying the Hi F premium?
Change to a Medi Gap plan with lower deductible under birthday rule?
Since you have Share of Cost Medi Cal, do you have to go to Medi Cal MD’s for the portion you pay?
See CA Health Care Advocates on Medi Gap & Medi Cal
If you drop your Medi Gap plan as it looks like you will have full scope medi cal, due to your tax loss – magi Income
There are guaranteed issue rules to let you get a Medi Gap plan, if you lose full scope Medi Cal