2025 Blue Shield Medicare Enrollment & FULL information & Details

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

.Steve's VIDEO Explanation Comparing what Medicare pays and what you get extra with MAPD or Medi Gap

• See full brochure I cut and pasted this from

• 2024 Fact Sheet Medicare Costs

  • "Hospital at Home" Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers Commonwealth Fund
  • Explanation from Fortune Magazine 

• Medi Gap – Supplement Plans

• Pays on top of Medicare Parts A & B – Any Medicare Provider 

  • Anthem Blue Cross  
  • United Health - Email us for Information
  • Blue Shield – Medi-Gap 
  • Health Net - Offers Hi G

Part B (Medical #Insurance)

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.

Steve's VIDEO Explanation

2024 Fact Sheet Medicare Costs

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
    • Hospice Coverage – Medicare
  • Togetherness – Loneliness Social Determinants of Health
  • Mental Health
  • How to sign up for Medicare?
  • FAQ Medical Necessity our Medical Necessity Webpage
  • Original Medicare & Medi-Gap – Supplement vs Medicare Advantage MAPD
  • Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care  AARP
    • medical news today.com/ medicare-max-out-of-pocket  

“FAQ’s

• Question I think it’s fairly simple — if you want the most coverage, you get Part A, B, D  Rx + Medi Gap Plan G..   Am I correct?
  • Answer Depends what you mean by “most.” Part A covers hospital. Part B doctor visits.  Part D covers outpatient prescriptions, rx. Plan G pays the co pays and most deductibles in A & B.   See the comparison chart
  • Some would say “most” might be a Medicare Advantage plan, in that the premiums are usually zerp. 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.
• Question I’m thinking of getting Hi F, with the $2,240 deductible. How do I know if that’s the right plan for me?
  • Answer 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   rates   from the Blue Shield Medi Gap Brochure above, or get quotes here.
  • 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.
• Question What’s the #difference between attained age, issue age and community rating?
• Answer
• View Larger Image
  • 
  • Image from Guide to choosing a Medi Gap Policy
  • Here’s our quote engine for the plans we do offer in CA.
    • AARP UHC has Community Rating  However, looking at their rate chart and 3%/year  enrollment discounts, it looks like attained age to me…
      • Email us [email protected] and we’ll send you the enrollment kit with the rates & details.
    • Transamerica has issue age – contact them directly.  We don’t represent them.  ^Source *
    • State of CA Department of Insurance Comparison Tool
      • Definitions attained ate, etc.
        • Federal Definitions
        •  CA Health Care Advocates
          • Community Rating – Glossary Same rate regardless of your age 
      • Medicare.gov  comparison tool
    • Insure Me Kevin.com Community vs Attained Age
•  FAQs / Ask Us a Question

• 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?
    • get quotes here.
  • 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

• 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.
  • On the other hand, the simple answer is  see the chart above for Part A Hospital and Part B Medical Services
  • 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.
      • cms.gov/ Medical Necessity Varicose Veins
    • 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
  • Costs
    • 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
  • 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/