advocate guide to Medi Cal

Medicare Funding
Medicare for All California AB 1400 – CalCare

How is Medicare #funded?


In 2011, Medicare covered 48.7 million people. Total expenditures in 2011 were $549.1 billion. This money comes from the Medicare Trust Funds.

Medicare Funding

Source KFF 

  • Part A Hospital is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each) (accounting for 88 percent of Part A revenue). Higher-income taxpayers (more than $200,000/individual and $250,000/couple) pay a higher payroll tax on earnings (2.35 percent).
  • Part B Doctor Visits is financed through general revenues (72 percent), beneficiary premiums (26 percent), and interest and other sources (2 percent). Beneficiaries with annual incomes over $85,000/individual or $170,000/couple pay a higher, income-related Part B premium reflecting a larger share of total Part B spending, ranging from 35 percent to 85 percent.
  • Part D Rx is financed by general revenues (71 percent), beneficiary premiums (17 percent), and state payments for beneficiaries dually eligible for Medicare and Medicaid (12 percent). Higher-income enrollees pay a larger share of the cost of Part D coverage, as they do for Part B.
  • The Medicare Advantage program (Part C) is not separately financed. Medicare Advantage plans, such as HMOs and PPOs, cover Part A, Part B, and (typically) Part D benefits. Beneficiaries enrolled in Medicare Advantage plans pay the Part B premium, and may pay an additional premium if required by their plan; about half of Medicare Advantage enrollees pay no additional premium. Kff *
  • See the Medicare & You Manual for more background information

Medicare Trust Funds

Hospital Insurance (HI) Trust Fund

How is it funded?

  • Payroll taxes paid by most employees, employers, and people who are self-employed – See publication 15 pdf
  • Other sources, like income taxes paid on Social Security benefits, interest earned on the trust fund investments, and Medicare Part A premiums from people who aren’t eligible for premium-free Part A

What does it pay for?

  • Medicare Part A (Hospital Insurance)benefits, like inpatient hospital care, skilled nursing facility care, home health care, and hospice care
  • Medicare Program administration, like costs for paying benefits, collecting Medicare taxes, and combating fraud and abuse

Supplementary Medical Insurance (SMI) Trust Fund

How is it funded?

  • Funds authorized by Congress
  • Premiums from people enrolled in Medicare Part B (Medical Insurance) and Medicare prescription drug coverage (Part D)
  • Other sources, like interest earned on the trust fund investments

What does it pay for?

  • Part B benefits
  • Part D
  • Medicare Program administration, like costs for paying benefits and for combating fraud and abuse  copied from Medicare.Gov
  • Learn More ==> Kaiser Foundation, including spending

This might end with AHCA – Replace Obamacare

See also our section on the ratio of Part B & D premiums to actual costs of Medicare.  

 FAQs / Ask Us a Question


How the $$$ is spent 

Medicare Expenses

Source KFF


Links & Resources







Gov. Gavin Newsom signed a unified healthcare financing bill, Senate Bill 770, into law on Oct. 7th. California has become the first state in the country to pass such a bill, paving the way towards greater healthcare equity and accessibility.

The bill requires the secretary of California Health and Human Services Agency (CalHHS) to consult with stakeholders and the federal government to pursue a waiver framework for a comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits. By Nov. 1st, 2025, the CalHHS secretary is required to provide the legislature and Newsom with a report of the finalized waiver framework. Read More State of Reform 


California SB 770

California #AB1400 

Guaranteed Health Care for All

The California #Guaranteed Health Care for All Act, CalCare,

AB 1400 DIED January 31, 2022 LA Times *


We are very concerned that Medicare for All, National Health Insurance, CalCare, etc. would be like Medi Cal, not some great wonderful thing that pays for any doctor, any hospital anytime for any reason and no concern about Narrow NetworksMedical Necessity  or MLR Medical Loss Ratio.

The California Guaranteed Health Care for All Act, CalCare, would provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

CalCare would cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children’s Health Insurance Program, Medi-Cal, &  Medicare program.


The Legislature finds and declares all of the following:

(1) PPACA Obamacare still leaves many Californians without coverage or with inadequate coverage.
(2) Californians, have experienced a rise in the cost of health care including rising premiums, deductibles, and copayments, as well as restricted provider networks and high out-of-network charges.
(4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans

********Then why does Medi Cal mandate that you have an Insurance Company HMO?

Why does Medicare seem to encourage Insurance Medicare Advantage Plans?

guided by the plan’s economic needs rather than patients’ health care needs.

*****And you don’t think the Government has the same problems?

(6) Billions of dollars that could be spent on providing equal access to health care are wasted on administrative costs necessary in a multiplayer health care system. Resources and costs spent on administration would be dramatically reduced in a single-payer system, allowing health care professionals and hospitals to focus on patient care instead.

***How much Fraud do we have in Government Programs?

(7) It is the intent of the Legislature to establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state.


(1)  universal health coverage for every Californian, funded by broad-based revenue.
(2) any federal funds would be paid by the federal government to the State of California
(4) Those programs would be replaced and merged into CalCare, which will operate as a true single-payer program.

(g) It is the further intent of the Legislature to address the high cost of prescription drugs and ensure they are affordable for patients.

FAQs / Ask Us a Question

Read the ACTUAL Bill and not just summaries….

California AB 1400
Actual Bill


One reason why nothing happened in 2021

The California legislature operates on a series of deadlines that are outlined in the Constitution and in Legislative Rules. There are deadlines to introduce bills, amend bills and have bills heard (i.e. voted on in a hearing) in a policy committee. The deadline for any bill with a fiscal component to be heard in a policy committee is next week, April 30th. On matters of health insurance and healthcare, virtually every bill has a fiscal component, so it must receive a majority of votes to pass out of policy committee (most often the Health Committee) or it is dead for the year. AB 1400 was held in the Assembly Rules Committee, and accordingly will not be heard in a policy committee in time to meet the legislative deadline necessary to advance  CAHU email dated 4.23.2021


Links & Resources

Health Insurance unfortunately is very complicated

President Trump February 27, 2017

#Medicare10050 and You  2024
Everything you want to know 

Steve's video on Medicare & You


your medicare benefits # 101116


What are the #threats to Medicare?
We paid for it for all our working career, can they take it away?


We have to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future.”

“The driver of our debt is the structure of Social Security and Medicare for future beneficiaries,”

No one should be fooled by this argument. Rubio is pursuing the classic strategy of the enemies of social insurance programs to make them increasingly irrelevant to future generations by promising cuts that the affected beneficiaries “wouldn’t really notice.” This only eases the path toward eliminating those programs outright.

But members of those future generations should take notice. Like today’s beneficiaries and those of the past, they’re paying for their future benefits with every paycheck, and they should be profoundly aware that Rubio and his fellow Republicans are merely preparing to rip them off.   Los Angeles Times 11.30.2017


Medicare was projected to become “insolvent” in 2026, three years earlier than was projected last year…  Social Security is stable, and in some respects, improving fiscally.  Read the actual article, this quote is what they are explaining.    Los Angeles Times 6.5.2018  GOP policies have hurt Social Security & Medicare


  • Trump on Social Security, Medicare cuts: ‘There is a lot you can do’
  • Medicare’s Independent Payment Advisory Board has been killed. It was authorized by the Affordable Care Act to serve as a check on higher Medicare expenses. It was quickly labeled a death panel by opponents and became such a lightning rod that no board members were ever named.
  • The rules for Medicare’s Part D drug plans were changed. The much-maligned coverage gap (or donut hole) in these plans has been shrinking for years under the Affordable Care Act, and was supposed to end in 2020, at which time consumers in the gap would pay no more than 25 percent of the costs of their drugs. That end date was moved up a year to 2019.
  • Consumers who have spent a lot on drugs and have entered the so-called catastrophic phase of Part D plans will pay no more than a few dollars for each prescription or, for costly drugs, no more than 5 percent of the cost of the drug. While this percentage will not change, the responsibility for paying the other 95 percent of the cost will be borne even more heavily by the government, and is expected to save pharmaceutical companies billions of dollars. Taxpayers, of course, ultimately will be on the hook for those higher government expenses. It’s a more significant if largely invisible change.
  • Medicare’s caps on covered expenses for outpatient therapyhave been officially repealed. People with persistent therapy needs have bumped against these caps for more than 20 years, and Congress has regularly eased those rules. While claims above current cap levels may be subject to review, people who legitimately need extensive therapy will not have to depend on year-to-year congressional fixes.
  • Medicare’s high-income premium surcharges will carry even more of a bite for wealthier enrollees. Those making more than $500,000 a year ($750,000 for couples) will pay 85 percent of the actual costs of Part B and D in 2019, up from 80 percent this year. Most Medicare enrollees pay premiums that equal about 25 percent of these costs.
  • Congress also made numerous and potentially far-reaching changes to the rules for Medicare Advantage plans.
    • That includes allowing such plans to pay for limited long-term care expenses – something that until now has not been covered by Medicare.
      • Air conditioners for people with asthma,
      • healthy groceries,
      • rides to medical appointments and
      • home-delivered meals

Resources & Links

CMS 2018 Annual Report on Medicare

Kaiser Foundation  Medicare Spending & Financing

All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy #Calculation
There is No charge for our complementary services

Guaranteed Issue - No Pre X Clause - Quote & Subsidy Calculation - No charge for our complementary services - If not in CA click here for Nationwide Quotes

Watch our 10 minute VIDEO
that explains everything about getting a quote

Full detailed explanation of how to use our quote engine video

Did Health Care Reform – #ObamaCare
make any Changes to Medicare?


  • Medicare Advantage
  • The federal government pays more for beneficiaries enrolled in Medicare Advantage plans than for beneficiaries in fee-for-service Medicare. [My understanding was that these plans were created to SAVE $$$]  That additional funding provides enrollees with additional benefits, such as reduced cost sharing and coverage of items not covered by traditional Medicare, which are seen as necessary to attract enrollees to these managed care plans. However, all Medicare beneficiaries, not just those enrolled in Medicare Advantage plans, have ended up footing the bill for these extra payments.
  • The new law freezes the extra Medicare payments to Medicare Advantage plans in 2011 and begins to reduce the payments to plans in 2012. It also requires Medicare Advantage plans to pay at least 85 percent of the premium dollars they collect for medical claims. However, it also makes it possible for Medicare Advantage plans to receive higher payments if they demonstrate that they are providing high-quality care to enrollees. Health
  • Federal reimbursement rates for insurance carriers administering Medicare Advantage products to performance, as measured by the Stars rating system. Bonus payments are attached to stars ratings, and bonus revenue will be awarded, gradually increasing with maximum bonus opportunity in 2014 Wikipedia 5 Star Rating System
  •  FAQs / Ask Us a Question
  • Medicare Part B premiums include a fee of  over $43.20 more each year to subsidize Medicare Advantage plans
  • I don’t have a citation, but I believe Medicare has more preventative care as Health Care Reform requires it for most everything else.
  • Quality Control – Medicare oversight of MAPD – Medicare Advantage Plans – Chinese Community Plan – censured
  • [CMS] “is establishing a policy to allow enrollees to switch plans when they are affected by significant mid-year provider network terminations initiated by their Medicare Advantage Organization without cause,”
  • The CMS now will require plans to give 90 days’ advance notice of “any significant changes to their provider networks in order to ensure help compliance with provider access requirements.”
  • Health plans, particularly UnitedHealth Group, had responded to expectations for lower rates by terminating providers from their networks—much to the surprise of doctors in Connecticut, Florida, Indiana, New Jersey, New York and Rhode Island in particular.
  • In October, plans said the terminations were being made in anticipation of rate cuts.
  • Medicare Advantage Cuts 2.28.2014
  • additional cuts could raise beneficiaries’ Medicare Advantage premiums by between $420 and $900 per year
  • ahip
  • modern
  • – Health Risk Assessment
  • AHIP info    See our Introduction to Medicare Page
  • Kaiser Foundation comparison  for 2017 bills

What is the #Additional Medicare Tax and Who Pays It?


Some taxpayers may be required to pay an Additional Medicare Tax if their income exceeds certain limits. Here are some things that you should know about this tax:

  • Tax Rate.  The Additional Medicare Tax rate is 0.9 percent.
  • Income Subject to Tax.  The tax applies to the amount of certain income that is more than a threshold amount. The types of income include your Medicare wages, self-employment income and railroad retirement (RRTA) compensation. See the instructions for Form 8959, Additional Medicare Tax, for more on these rules.
  • Threshold Amount.  You base your threshold amount on your filing status. If you are married and file a joint return, you must combine your spouse’s wages, compensation or self-employment income with yours. Use the combined total to determine if your income exceeds your threshold. The threshold amounts are:
Filing Status Threshold Amount
Married filing jointly $250,000
Married filing separately $125,000
Single $200,000
Head of household $200,000
Qualifying widow(er) with dependent child $200,000

If you owe this tax, file Form 8959, with your tax return. You also report any Additional Medicare Tax withheld by your employer on Form 8959. Visit for more on this topic. You can also get forms and publications on anytime.

Each and every taxpayer set of fundamental rights they should be aware of when dealing with the IRS.  These are your Taxpayer Bill of Rights. Explore your rights and our obligations to protect them on

Additional IRS Resources:

#Actual Cost for Medicare to Provide you the Medical Benefits

While you might complain about the premiums you pay for Medicare A, B & D is a small portion of what Medicare is contributing to the actual cost to provide Coverage, it's only 25 percent of Part B and Part D program costs.


Part D & B premiums

Source Kaiser Foundation 




Hitler & Mental Health Disabilities T 4 

Speak up!  Do want you can to make sure this doesn't happen in the USA! 

Translation for the poster below:

"This person suffering from hereditary defect  costs the community $60,000 Reichsmark during his lifetime. Fellow German, that is your money, too. Translation & Image Courtesy of Psychology 

nazi t 4 program


Under  the T 4 program, T4  Certain German physicians were authorized to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death" (Gnadentod).[7] The T4 programme stemmed from the Nazi Party policy of "racial hygiene", a belief that the German people needed to be cleansed of racial enemies, which included anyone confined to a mental health facility and people with simple physical disabilities.[31] T4  

The annual cost for a bed in a CDCR-operated, inpatient psychiatric program is around $301,000


Medi Cal Network #Limitations 

See the next “module” below for the  plans and doctors you have to choose from on Medi-Cal.  Do you really want Medi Cal expanded to everyone?

Take a look at Our  Medi Cal webpages, let alone the ones we took down as we are not paid a PLUMB NICKEL to help people with Medi Cal.  How’s that for funding?  Look how many FAQ’s we get as Medi Cal doesn’t have the staff or time to help people!  Do Medi Cal, Insurance Company, Salaried Personnel have the background, caring or time to answer questions.  Here’s 17 reasons to use Steve Shorr Insurance.


#My Medi-Cal 
How to get the Health Care
You Need

24 pages

Smart Phones - try turning sideways to view pdf better
My medi cal explanation of medi cal

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