HICAP Case Studies

The following scenarios depict typical cases where HICAP has assisted their clients with their concerns about Medicare:

What will happen to my house? Will Medi-Cal take it when I die?

Angela's income is less than $600 per month. She has been hesitant to contact social services about Medi-Cal because she heard that when she dies, Medi-Cal will claim her home and she wants to leave it to her son.

The counselor gave Angela a fact sheet called "California's Medi-Cal Recovery Program: Frequently Asked Questions." Because the HICAP Program does not counsel people about Medi-Cal, the counselor referred Angela back to Medi-Cal. The counselor helped her apply with the Social Security Administration for the "Extra Help" program.

Angela may contact an estate planner concerning her house, and will contact Medi-Cal for an application.

If I expire before my spouse, will she lose her health insurance?

Joseph will retire this month. His union plan with medication coverage will cost about $700 or more per month to dually cover him and his spouse. Joseph's spouse is currently on Medicare and is also covered by the union plan. His concern is that if he expires first, will her coverage terminate?

Joseph should call his Union plan to ask if his wife will be able to continue the Union plan if he passes away.  In many cases the Counselor explained if Joseph died first, his spouse would be able to apply for a Medigap Plan and Part D. Fact sheets were given to Joseph that explain his "Rights to Purchase a Medigap (B-005) and Part D with "creditable" drug coverage through an Employer Group Health Plan. The counselor also advised him to check the Veteran's Association for medication and other services. The counselor suggested that Joseph contact the Department of Veteran's Affairs to inquire about his eligibility for other benefits.

Joseph should call his Union plan to ask if his wife will be able to continue the Union plan if he passes away.  In many cases the Counselor explained if Joseph died first,

Joseph will investigate a Medigap and Medication plan and contact the VA. Potentially, he can save $300 to $350 per month. The counselor informed the client that he would be available for future discussions required.

I tried to fill my prescription, but was denied at the pharmacy! What happened?

Louise was disenrolled from AARP Part D Saver plan and did not know she had to apply for a new plan. Consequently her prescription was denied at the pharmacy.

The counselor told Louise that she had until the end of next February to apply for a new plan. The counselor researched Louise's medication on the Medicare website and observed that the AARP Preferred Plan would be the best match for her. The counselor enrolled Louise in the AARP Preferred Plan and gave her a Confirmation printout from the Medicare website. She should call the counselor if she needs any future assistance.

My mother lives outside of her insurance plan's service area. What other options do we have?

Tony's mother is currently enrolled in a Medicare Advantage Plan through her husband's CalPERS Plan. They want to consider other options because her residence is out of the plan's service area and they must travel a great distance to obtain services.

The counselor reviewed individual Medicare Advantage Plans, Medigap options (Fact Sheet B-002) and the prescription drug plan matrix. CalPERS options were reviewed. The discussion then focused on comparing plans and strategies for making a decision appropriate to the client's need. The client is computer literate and the Medicare.gov website was accessed to navigate and compare prescription drug plans.

Tony appreciated the counseling discussion and said he now has the information to make an appropriate decision when the CalPERS Sept/Oct open enrollment period occurs.