What is Medicare?
Medicare is our country’s health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, or permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease), can also qualify for Medicare.
The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have original Medicare coverage, you can buy a Medicare supplement policy (called Medigap) from a private insurance company to cover some of the costs that Medicare does not. A portion of the payroll taxes paid by workers and their employers cover most Medicare expenses. Monthly premiums, usually deducted from Social Security checks also cover a portion of the costs. The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. But, you apply for Medicare at Social Security, and we can give you general information about the Medicare program.
Medicare has four parts
• Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay). Part A also pays for some home health care, and hospice care.
There is a dedutible around
• Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
• Medicare Part C (Medicare Advantage) includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services.
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.
Medicare Part A (Hospital Insurance) Costs
Part A Monthly Premium Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $437 each month. Hospital Stay in 2019, you pay (all payment will be updated each year)
■ $1,364 deductible per benefit period
■ $0 for the first 60 days of each benefit period
■ $341 per day for days 61–90 of each benefit period
■ $682 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime) Skilled Nursing Facility Stay in 2019, you pay
■ $0 for the first 20 days of each benefit period
■ $170.50 per day for days 21–100 of each benefit period
■ All costs for each day after day 100 of the benefit period
Medicare Part B (Medical Insurance) Costs
Part B Monthly Premium the Standard Part B premium amount in 2019 is $135.50 or higher depending on your income. However, most people who get Social Security benefits pay less than this amount ($130 on average). Social Security will tell you the exact amount you’ll pay for Part B in 2019. You pay the standard premium amount (or higher) if:
■ You enroll in Part B for the first time in 2019.
■ You don’t get Social Security benefits.
■ You’re directly billed for your Part B premiums.
■ You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $135.50 in 2019.)
■ Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.
Source: SSA.gov
What is Covered California?
Covered California is where Californians can get brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place to get federal premium assistance to help you buy health insurance from the companies shown below. That means you may qualify for a discount on a health plan through Covered California, or get health insurance through the state’s Medi-Cal program. Either way, you’ll have great health coverage.
Everyone Can Apply
Both lawfully present and not lawfully present individuals can apply through Covered California to see if they are eligible for a health plan through Covered California or Medi-Cal. There is no “waiting period” or “five-year bar.”
Immigrants who are not lawfully present do not qualify for a health plan through Covered California; however, they may qualify for coverage through Medi-Cal up to age 19 or for pregnancy coverage. Immigrants who are not lawfully present can also buy private health insurance on their own outside of Covered California. Additionally, some counties offer other health care options for immigrants who are not lawfully present.
Financial Help
Lawfully present individuals who meet all other eligibility requirements, such as income requirements and California state residency, may be eligible for financial assistance to purchase a health insurance plan through Covered California. Or they may be eligible for free or low-cost coverage through Medi-Cal.
Covered California offers coverage from these health insurance companies.
- Anthem Blue Cross
- Blue Shield of California
- CCHP Health Plan
- Sharp Health Plan
- Kaiser Permanent
- LA Care Health Plan
- Molina Health Care
- OSCAR
- Health Net
- Valley Health Plan
- Western Health Plan
These health insurance companies meet all the state and federal requirements for plans as well as additional standards established by Covered California. They represent a mix of major insurers and smaller companies, regional and statewide doctor and hospital networks, and for-profit and nonprofit plans. They deliver exceptional value and choice with affordable premiums, a wide choice of benefit levels and good access to doctors and hospitals in all areas of the state.
Californians with limited incomes may be eligible for Medi-Cal.
Open enrollment begins on Oct.15, 2019, but individuals with qualifying life events can enroll at any time of the year. Medi-Cal enrollment is also year round. Medi-Cal and Covered California use the same application. After you enter your information, you will find out whether you qualify for Medi-Cal or Covered California.
Source: CoveredCA.com
More Services
In addition to health insurance, our agency also specializes in personal and commercial lines of insurance. We will make every effort to get each client the most competitive rate with the best service. No need to spend hours making calls to get an insurance quote; we do the work for you. Simplicity is the key! We are specialized in the following categories:
- Auto
- Home
- Life
- Umbrella
- Motorcycle
- Health
- Commercial Workers Compensation
- General Liability
- General Contractor's Liability
- Apartment Building and Bond
