CCHP Medicare “Cost” HMO
(Not a Medicare Advantage Plan)
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Two Medicare “Cost” HMOs are available in Contra Costa County. These uncommon plans are offered through Contra Costa Health Plan and are not Medicare Advantage plans. There are no income restrictions for enrolling in the plans. Enrollment in Medicare Part A and Part B is required, and members must reside in Contra Costa County.
In these plans members can use network providers and facilities. For nearly all services there are no co-pays. Members can also use their Medicare card outside the plan. In that case Medicare deductibles and co-insurance would apply.
The plans DO NOT include drug coverage, but members can enroll in a Stand-Alone Prescription Drug Plan. If they choose not to enroll in a Prescription Drug Plan and do not have other coverage, a late enrollment penalty will apply if they join a Prescription Drug Plan later.
Beneficiaries can enroll in a Prescription Drug Plan plan during the Open Enrollment Period from October 15 to December 7. The prescription drug coverage will be effective January 1 of the following year. Individuals who are new to Medicare or who are losing other coverage have special rights to join a Part D plan at other times.
These plans, Senior Health Basic and Senior Health Plus, have open enrollment. That is, individuals with Original Medicare can enroll in these plans at any time during the year.
Both plans include case management and an advice nurse. Senior Health Basic includes emergency and urgent care in the U.S.A. Senior Health Plus includes world-wide emergency and urgent care.
The network for Senior Health Basic includes all the Contra Costa Health Plan facilities and physicians.
The network for Senior Health Plus includes not only these providers but many other community providers as well, including John Muir Medical Center and many John Muir physicians. (Clients who wish to know if a specific physician or facility is included in the network can do a search on the CCHP website.) This plan also includes some dental, eyeglass, chiropractic, and acupuncture coverage.
This abbreviated chart outlines the key features of both plans. Note that for most services there are no co-pays.
|Senior Health Basic||Senior Health Plus|
|CO-PAYS IN NETWORK:|
|Doctors’ office visit||$0||$0|
|Mental health/substance abuse||$0||$0|
|Ambulance||$0 in Contra Costa County; $50 out of County|
|Diagnostic lab & X-ray||$0||$0|
|Diabetes Supplies & Training||20% for supplies; $0 training|
|Durable Medical Equipment||$10||$10|
|Outpatient Rehab. (PT, OT, ST)||$0||$0|
|Chemotherapy – Part B||$0||$0|
|Preventive care, per Medicare||$0||$0|
|NO DRUG COVERAGE, but members should purchase a Stand-Alone Prescription Drug Plan|
|Senior Health Basic:
Must use CC County facilities
Emergency/Urgent Care in USA
|Senior Health Plus:
Worldwide Emergency/Urgent Care
Vision $0; 1 visit – 2 years; Eyewear allowance
Routine Dental – $10/visit – 2/year; 40% co-pay
Hearing 45% co-pay/hearing aid every 5 years
Chiropractic/Acupuncture $0/20 visits (total)/year
Expanded network of providers including John Muir
|Contra Costa Health Plan Clinic Locations: Antioch; Bay Point; Brentwood; Concord; Martinez; Pittsburg; Richmond; San Pablo|
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