Where can I turn to learn?
HICAP the Medicare Health Insurance Counseling and Advocacy Program provides educational presentations in your community. As a truly unbiased source for Medicare information, you can be assured you will receive accurate and comprehensive information. HICAP does not sell anything and is not affiliated with any insurance company nor agent. Our funding is via the Older Americans Act and the CA Department of Aging in partnership with the Area Agency on Aging and Senior Advocacy Services.
Attend a Medicare Fundamentals, Understanding Your Medicare, Medicare Annual Choices & Changes or Preventing Medicare Fraud seminar. For dates and times of the nearest presentation, Click here.
#1 - What is Medicare?
Medicare is the Federal health insurance program established in 1965 which is administered by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health Services. Medicare is health insurance for the following people:
- Age 65 or older;
- Under age 65 with certain disabilities who qualify for disability benefits from Social Security or Railroad Retirement Board (RBB);
- Any age with End-Stage Renal Disease (ESRD) – permanent kidney failure requiring dialysis or a kidney transplant;
- Diagnosed with ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s Disease) the month your disability benefits begin.
#2 - How Do I Enroll in Medicare Part A (Hospital) and Part B (Medical)?
- If you aren’t getting Social Security or Railroad Retirement (RRB) benefits, you will need to sign up in one of three ways: 1) online at www.socialsecurity.gov; 2) call Social Security at 1-800-772-1213; or 3) visit your local Social Security Office.
- In most cases, if you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
- If you’re under 65 and disabled, you automatically get Part A and Part B after you get Social Security disability benefits (SSDI) or certain disability benefits from the RRB for 24 months.
#3 - What Does Medicare Part A (Hospital) Cover?
Medicare Part A (Hospital) covers the following services:
- Inpatient care in hospitals;
- Inpatient care in a skilled nursing facility (not custodial or long-term care);
- Home health care services;
- Hospice care services;
#4 - What Does Medicare Part B (Medical) Cover?
Medicare Part B (Medical) covers:
- Doctor’s services and tests;
- Outpatient care;
- Home health care services;
- Durable medical equipment and other medical services;
- Ambulance services;
- Chiropractic services;
- Diabetes supplies;
- Preventive services.
#5 - What Is Not Covered by Medicare Part A and Part B?
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. Some of the items and services that Medicare does not cover include the following:
- Long-term care;
- Routine dental care;
- Cosmetic surgery;
- Hearing aids;
- Exams for fitting hearing aids.
#6 - What are Medicare Advantage (MA) Plans (Part C Plans)?
Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. MA plans in Lake, Mendocino, Marin, Napa, Solano and Sonoma counties may include Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPO’s); Private Fee for Service (PFFS); and Special Needs Plans (SNP’s). For more information about which companies and plans are offered in your county, a brief description of benefits, and the rules for joining, changing, or disenrolling from a plan, call the HICAP office at 1-800-434-0222.
Definitions of Medicare Advantage (MA) Plans; otherwise known as Part C:
Each January plans change and different Medicare Advantage plans are available. When you
sign up for a Medicare Advantage plan, you assign your Medicare Part A and Part B over to the plan.
Your plan determines what is covered and what is not covered. The definition for each of these
plans is below:
1. Health Maintenance Organization (HMO) plan: HMO Plans must cover all Medicare Part A and Part B
health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can
only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Your costs
may be lower than in the Original Medicare Plan.
2. Special Needs Plan (SNP): Medicare Special Needs Plans’ (SNP) are specially designed for people
with certain chronic diseases and other specialized health needs. These plans are only available
for specific groups of people, such as people living in certain long-term care facilities (like a
nursing home), people eligible for Medicare and Medicaid (Medi-Cal in California), or people with
certain chronic or disabling conditions. All Medicare SNPs provide Medicare prescription drug
coverage (Part D).
All Medicare Advantage (MA) plans must adhere to the guidelines established by the Centers for
Medicare & Medicaid Services (CMS) and must provide all of the benefits covered under Original
MA plans are Individual Plans for people who do not qualify for an Employer Group Health Plan
(EGHP). Converting an EGHP from actively working to a retiree plan, and going on Medicare may
change your benefits and premiums.
HICAP provides one-on-one counseling to help you compare your current EGHP plan with individual
Medicare Advantage plans (HMO and PPO) and Medicare Supplement (Medigap) plans.
IMPORTANT: Each year between October 15 – December 7, Medicare beneficiaries can review upcoming changes to Advantage plans and decide whether they want to change plans or transition back into Original Medicare. Whatever changes are made during this Annual Enrollment Period (AEP), take affect beginning January 1 of the new year. The AEP is the time of year to make changes.
HICAP is here as your unbiased source for Medicare information. HICAP does not sell anything. Contact us for an appointment in your community to understand your Advantage plan options.
#7 - What is Medicare Part D (Prescription Drug Plan)?
Medicare offers prescription drug coverage to beneficiaries. Even if you don’t take a lot of prescriptions now, you should still consider joining a Medicare Prescription Drug Plan(PDP) to avoid the late enrollment penalty which would result in a permanent, higher monthly Part D premium. To get Medicare Part D prescription drug coverage, you must join a plan contracted with an insurance company or other private company approved by Medicare. Each plan varies in cost and covered medications. If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage, you will pay a late enrollment penalty.
The plan you choose is specific to your medications. You are welcome to complete a search at Medicare.gov or have HICAP complete a Free search to determine the 3 least expensive plans specific to your medications. This is a free and unbiased service HICAP offers. For assistance, call HICAP at 1-800-434-0222 or Click here to submit your search request electronically.
HICAP does not sell anything nor receive any compensation from insurance plans to complete a detailed search on your behalf.
Consider attending an unbiased educational seminar by HICAP entitled Medicare Annual Choices & Changes. For the seminar calendar click here.
IMPORTANT: Each year Part D plans change premiums, formularies and contracts. October 15 – December 7 is the Annual Enrollment Period to review the upcoming plans, have a search completed, and decide whether there is a less expensive plan which will cover your specific medications. If you make a change during this period, your new coverage begins in January of the new year.
#8 - How Can I Get Help Paying for my Prescription Drugs?
You may qualify for “Extra Help”, also called the low-income subsidy (LIS), from Medicare to help pay prescription drug costs based on your yearly income and resources.
HICAP counselors can assist you in understanding the income qualifying thresholds and application process through the Social Security’s website. Call HICAP at 1-800-434-0222 to schedule an appointment with a counselor in your area who can help explain the “Extra Help” program or click here to request an appointment online.
#9 - What Other Low-Income Programs are available?
You may qualify for the Medicaid (Medi-Cal in California) program or any of the Medicare Savings Programs (MSP) if you meet certain monthly income and asset levels. To find out more information about these programs, contact the CA Department of Healthcare Services or Click here for further information.
HICAP assists with Medicare counseling and education.
#10 - What are Medicare Supplement Plans (Medigap Plans)?
A Medigap policy otherwise know as a Supplemental insurance policy is an insurance product, sold by private insurance companies and can help pay some of the health care costs (“gaps”) related to Parts A and B that Original Medicare doesn’t cover, like deductibles, copayments and coinsurance. Medigap policies are standardized. To better understand this insurance product and for more information on what companies sell Medigaps and the benefits for each, call HICAP at 1-800-434-0222 or request a 1-on-1 appointment with a counselor in your area. Click here to request an appointment.
HICAP does not sell anything and does not endorse any insurance plans, companies nor agents.
#11 - What if I am still covered by my Employer Group Health Plan when I become eligible for Medicare (either while I am still working or now that I have retired)?
Do you have, or are you eligible for other types of health insurance or prescription drug coverage (like from a former or current employer or union)? If so, read the materials from your insurer or plan, or call them to find out how the coverage works with Medicare. If you have coverage through a former or current employer or union or other source, talk to your benefits administrator, insurer or plan before making any changes to your coverage. If you drop your coverage, you may not be able to get it back.
This website is not intended to address the complexities that can affect Medicare beneficiaries.
HICAP has Certified counselors in your community to educate and advocate. Click here to request an appointment.