Blue Shield of CA Medicare – Medi-Gap – Supplement Plans

Medi Gap  plans allow you to go to ANY Doctor or Hospital that accepts Medicare 

Medi Gap Introduction 

A Medi-Gap 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  (HMO) 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 *

Scroll or jump down to see a side by side comparison of what Medicare Pays, what Medi Gap pays and then what you pay

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Blue Shield Supplement - Medi Gap

Plans at a Glance
rev 1.1.2022

Blue Shield Medi Gap Plans at a Glance

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Enrollment #Kit
January 2022 Revision

Blue Shield Medi Gap Enrollment Kit

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.

VIDEO Explanation 

Medi Gap what medicare pays

See 2022 Updates

Medi Gap – Supplement Plans 

VIDEO Seminar - Introduction to #MediGap

by Steve

Medi Gap Introductory Video

Medi Gap A - N #Chart
Rev. 1.2022
Click link or image to enlarge

Plan A - N chart a - n chart

 

NAIC Draft Chart for 2020

What is a better choice for Me?

Evidence of Coverage

2022 Open Plans

Plan A 
Plan F Extra* 
Plan G 
Plan G Extra 
Plan G Inspire 
Plan N 

<<<<<<<<<<<<<<<<<Historical>>>>>>>>>>>>>>>>>>>>>>

 

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)

(Email us if the links require a password) 

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)

Blue Shield Videos On Medicare 

you tube videos

“Medicare Enlightenment” video series out now!

Child & Related Pages – Site Map 

[child-pages]

How does Medi Gap Plan Hi F pay for Hospital Care, Long Term #Acute Hospital, Sub Acute Care, 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?

 

 

hi f part a hospital

Email us [email protected] for Source Brochure

skilled nursing hi f

References, Links & Bibliography 

  • Coverage
    • Medicare.Gov  Glossary
    • Definitions 
  • 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
  • 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,

               cms.gov/Physician Fee Schedule
          health care value hub.org/medicare-rates-benchmark-too-little-or-just-right
          AHA.org Fact Sheet
          Kaiser Health News What A Hospital Charges Vs. What Medicare Pays

          medicare vs actual bill

          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   &  Clinical Guidelines
  • What is #Subacute Level of Care?
    • Sub acute rehab (also called subacute rehabilitation or SAR) is complete inpatient care for someone suffering from an illness or injury. SAR is time-limited with the express purpose of improving functioning and discharging home.1

      SAR is typically provided in a licensed skilled nursing facility (SNF).

      • A hospital, which is sometimes called “acute care,” is appropriate only for significant medical issues with the goal of a very short stay.

        An acute rehab center is designed for high-level rehab needs, typically requiring more than three hours a day of physical, occupation, or speech therapy

        Sub acute rehab (SAR) centers are usually most appropriate for people who need less than three hours of therapy a day, thus the label of “sub acute,” which technically means under or less than acute rehabVery Well.com *

    • Subacute patients are medically fragile and require special services, such as inhalation therapy, tracheotomy care, intravenous tube feeding, and complex wound management care.
      • Adult subacute care is a level of care that is defined as comprehensive inpatient care designed for someone who has an acute illness, injury or exacerbation of a disease process.
      • Pediatric subacute care is a level of care needed by a person less than 21 years of age who uses a medical technology that compensates for the loss of a vital bodily function.
      • There is some confusion, IMHO on if this is Hospitalization or Skilled Nursing dhcs.ca.gov * Cedars Sinai * Knollwood Nursing Center *
    • Subacute care, or subacute rehabilitation (SAR) is care received inpatient when recovering from an injury or illness. The care is usually received in a skilled nursing facility (SNF). Medicare World *
    • Review of the subacute care literature
    • Which patients benefit from Subacute care?
    • B. Subintensive Care Type Units.–Some hospitals have units which provide a level of care between other general routine and intensive care. These units are typically designated as subintensive, subacute, progressive, intermediate care units, etc. CMS.gov *
    • Medicare Benefit Policy Manual Chapter 8 – Coverage of Extended Care (SNF) Services Under Hospital Insurance  CMS.gov *
    • Subacute level of Care in a Skilled Nursing Facility (SNF) under Medicare Part A
    • OVERVIEW: Subacute nursing and rehabilitation services: services, furnished pursuant to physician orders, for members that are in a Skilled Nursing Facility and covered by Medicare Part A, that:• Require the skills of qualified technical or professional health personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech-language pathologists or audiologists.
      • Must be provided directly by or under the general supervision of these skilled nursing or skilled rehabilitation personnel to assure the safety of the patient and to achieve the medically desired result.  and
      • Require a short term, goal-oriented treatment plan including complex skilled nursing care and/or high intensity level skilled rehabilitation.NOTE: Subacute care is generally more intensive than traditional nursing facility care and less intense than acute care.  Common Wealth Care
    • Medical Necessity Guideline
      Some examples of complex medical conditions that may require subacute skilled nursing or rehabilitative care:• Presence of serious injury or illness that requires inpatient treatment but not acute hospital care
      Ventilator Program
      • Complex Respiratory Care and Treatments
      • Specialized Infusion Therapy
      • Brain Injury Rehabilitation
      • High Intensity Stroke
      • High Intensity Orthopedic Program
      • Specialized Post-Surgical Recovery Programs
      • Complex pain management Common Wealth Care

“FAQ’s

  • 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?
    • 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.

18 comments on “Blue Shield – Medi-Gap – Any Medicare Provider

  1. My husband turns 65 in June and I turn 65 in January of 2023.

    We are both currently covered under my husband’s work for health insurance.

    In January 2023 we would both like to be on Medicare with a good ppo policy.

    If my husband signs up in June I could lose coverage for 6 months.

    What can we do?

  2. 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.

  3. 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?

      FYI Clinical Bulletin for Varicose Veins

      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. your plastic surgery guide.com/varicose-vein

      Medicare does cover the medical treatment of varicose veins that cause symptoms and have ultrasound characteristics of chronic venous insufficiency. cleveland clinic.org/health/chronic-venous-insufficiency

      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. vanish leg veins.com/does-medicare-cover-varicose-vein-treatments/

      cms.gov/ Medical Necessity Varicose Veins

      Sorry, but this question is really beyond my pay grade.

      President Obama on when human rights begin.. a baby – fetus above his pay grade VIDEO

  4. 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?

    • See our Plan A through N Chart above.

      The main difference in Extra or Innovative is the Hearing Aids, Vision, Teledoc, Over the Counter Medications and Help, I’ve fallend and I can’t get up. See the summary of benefits for more detail.

      Blue Shield and other companies all have a “Birthday Rule” where you can the same or lesser coverage around the time of your birthday.

      Extra and Innovative plans will be considered the same and not better.

      Why are Medi Gap companies offered more benefits?

      One reason is a new buzz word, Social Determinants of Health.

  5. 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

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