Note: If you are new to Medicare it is important to select appropriate additional coverage.
Important Timing Issues:
- It is important to make timely decisions about the Medicare plans you wish to have. You can make choices during your initial enrollment period or a special enrollment period, if you’re entitled to one. If you do not join a Prescription Drug Plan or a Medicare Advantage Plan your coverage will revert to Original Medicare with no drug plan. You may have to wait until the next open enrollment period to enroll in one of these plans. In that case coverage won’t be effective until January of the following year.
- If you have Original Medicare you generally will have a 6-month open enrollment period after you are first enrolled in Medicare Part B to purchase a Medigap policy (Medicare supplement.)
- If you have Original Medicare you can join a Contra Costa Health Plan at any time, but drug coverage is not included.
- You can also join a 5 star Medicare Advantage plan at any time. In 2016 Kaiser Senior Advantage is the only 5 star plan in Contra Costa County
- If you don’t have prescription drug coverage you may be subject to late enrollment penalties. Avoid problems. Click here for a list of HICAP counseling locations throughout Contra Costa County with phone numbers and make an appointment for one-on-one counseling.
Read on for information about each of your options and to see charts of all the choices available in Contra Costa County this year.
Medicare Plans for 2016
Medicare Advantage Plans with Prescription Drug Coverage for 2016
Medicare Advantage (MA) plans are private insurance plans approved and subsidized by Medicare. They offer equivalent benefits to Medicare and are an alternative way of receiving Medicare coverage. Joining a Medicare Advantage plan means you may not use your Medicare card outside the plan. All the Medicare Advantage plans in Contra Costa County are HMO’s. That means you must use the plan’s network providers. All include Part D prescription drug coverage.
Eligibility for these plans is based on your residence. Some are offered for the entire county, and some are limited to certain zip codes. (See the chart for details.) Anyone can join a Medicare Advantage plan except persons with end stage renal disease.
Unless you are in your initial Medicare enrollment period or a special enrollment period, you can only join or leave a plan at certain times. Open enrollment occurs each year between October 15th and December 7th.
- Six Medicare Advantage (HMO) Plans with prescription drug coverage (MAPDs) are offered in Contra Costa County for 2016.
Monthly premiums range from $0 to $106.
There is one Special Needs Medicare Advantage Plan with prescription drug coverage that is offered only for persons who have Medicare and full scope Medi-Cal for 2016.
Click here for a chart showing a summary overview of the Medicare Advantage plans offered in 2016.
Click here for a chart showing the details of the Medicare Advantage plans offered in 2016.
Click here for more information about the Special Needs Medicare Advantage plans offered in 2016.
Switching to a 5-Star Plan
At any time during 2016 you have the right to enroll in a 5-star plan. This applies whether you have Original Medicare, with or without a Prescription Drug Plan, a Medicare Advantage Plan, or Contra Costa Health Plan. One 5-Star Medicare Advantage plan is available in Contra Costa County for 2016, the Kaiser Senior Advantage plan. Note that the 5-Star option can be used only one time each year.
Medigap (Medicare Supplement) Policies for 2016
- Medigap (Supplement) policies are private insurance policies designed to pay the portion of covered medical costs that Medicare does not pay—that is, the deductibles and coinsurance. Medicare pays its share of the Medicare-approved amount, then your Medigap policy pays its share. Different Medigap plans are offered, designated by letters (A-N), but all plans with the same letter designation offer the same coverage. Some plans will pay all the deductibles and co-insurance.
- You must have both Medicare Parts A and B to purchase a Medigap plan.
- Medigap policies will not pay for medical costs that are not covered by Medicare, although some policies add limited foreign emergency travel coverage.
- Medigap policies do not include prescription drug coverage, so members should also enroll in a Stand-Alone Prescription Drug Plan (PDP). Click here for more information about Stand-Alone Prescription Drug Plans.
- Note: All physicians, physician groups, labs, and hospitals that accept Medicare patients also accept all Medigap policies. With a Medigap policy you use both your Medicare card and your Medigap card. There are no networks, and prior approval is not required, as long as the provider accepts Medicare.
There are separate Medigap policies for those 65 and older and those who are under 65 and are eligible to purchase a Medigap policy.
Click here for a chart of Medigap policies offered in 2016 for people who are 65 and over.
Click here for a chart of Medigap policies offered in 2016 for people who are under 65 on Medicare due to disability.
Contra Costa Health Plans for 2016
- Two options for the Contra Costa Health Plans are available in 2016. These are HMOs but are not Medicare Advantage Plans. Click here for a chart of the Contra Costa Health HMO “Cost” Plans for 2016.
- These plans do not include prescription drug coverage, and members should also enroll in a Stand-Alone Prescription Drug Plan (PDP). Click here for more information about Stand-Alone Prescription Drug Plans.
- When considering a Contra Costa Health HMO “Cost” Plan, beneficiaries should confirm that their preferred physicians, physician groups, and hospitals are covered by the plan. However, unlike Medicare Advantage plans, the Contra Costa Health HMO Cost Plans do allow you to go outside the network and get benefits under Original Medicare.
Stand-Alone Prescription Drug Plans for 2016
- Stand-Alone Prescription Drug Plans are normally for those who do not enroll in a Medicare Advantage Plan. That includes those who elect to use just Original Medicare, or who also select a Contra Costa Health Plan or a Medigap Policy.
Click here for a chart of Stand-Alone Prescription Drug Plans offered in 2016.
Special Needs Medicare Advantage Plan
- The Kaiser Senior Advantage Medicare-Medi-Cal Plan is ONLY for “dual eligibles” — persons with Medicare and full scope Medi-Cal.
- This plan has $0 premium and $0 co-pays for virtually all services except the small co-pays for prescription drugs. Some additional benefits are included, such as (limited) dental coverage.
- Click here for summary overview of the Kaiser Senior Advantage Medicare-Medi-Cal Plan for 2016 (the column in the chart that has a grey background).
- Click here for a detailed 2 page chart of the Kaiser Senior Advantage Medicare-Medi-Cal Plan for 2016