The purchase of health insurance is one of the most important business or personal transactions you'll make.
Smart shopping takes time and effort, but will pay off in the long run. You'll gain a better understanding of the insurance you have and what your insurance needs might be. You'll gain more control over what your insurance will do. And, hopefully, peace of mind will result from knowing you have the information you need to get the best insurance for your own situation.
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Helpful Hints When Buying Health Insurance
Medicare, Medi-Gap, Medi-Cal and Medicare HMOs
Long-Term Care
Helpful Hints When Buying Health Insurance
- Do not buy more policies than you need.
- Know the agent and the company they represent.
- Know who to contact and where to go for help with a claim.
- Never pay cash. Always use a check or money order made out to the company.
- Beware of illegal and scare-tactic sales presentations.
- Do not withhold medical information when applying for insurance.
- Check for pre-existing-condition exclusions and waiting periods.
- Be careful about replacing existing coverage.
- Get a written outline of coverage and exclusions.
- Be sure there is a "free-look" provision.
- Take your time.
Medicare, Medi-Gap, Medi-Cal and Medicare HMOs
What is Medicare?
Medicare is a federal health insurance program for older and/or disabled persons. The program is divided into two parts: Part A (hospital insurance); and Part B (medical insurance).
How Do I Apply for Medicare?
Medicare applications are handled through your local Social Security office. It's a good idea to apply three months before your 65th birthday. For detailed information about Medicare, get a free copy of Your Medicare Handbook by calling 800/638-6833 or web site: http://www.hcfa.gov.
What is Medi-Gap?
A Medicare supplemental policy - Medi-Gap - is a type of insurance that is designed specifically to cover part or all of Medicare's co-payments and deductibles.
A Medi-Gap policy must be labeled "Medicare Supplemental Coverage." Generally, this type of insurance is available to persons 65 and over who are covered by both Medicare parts, A and B. Medi-Gap policies are designed to go along with, or track, Medicare. Therefore, many of the services excluded by Medicare are also excluded by Medi-Gap policies.
What is Medi-Cal?
Medi-Cal is California's health care program for low-income persons. Medi-Cal incorporates and supplements the federal Medicaid program.
Requirements change frequently. Currently, to be eligible, a senior must be 65 or be disabled - and be of low income. Call your local Social Security office for more information regarding Medi-Cal.
What is a Medicare HMO?
A Medicare HMO is a health plan that combines coverage of health-care costs and delivery of health care for a prepaid premium from Medicare.
Members receive services from personnel employed by or under contract to the HMO. HMOs generally require a patient to select a primary-care physician (PCP) who will coordinate his or her care. The member usually needs a referral from the PCP before he or she can go to a specialist/hospital.
Questions to ask before joining an HMO:
- What are your rights and responsibilities as a plan member?
- What are the limits on prescription drugs?
- Where can you buy your drugs and receive coverage?
- How does the plan protect confidentiality of medical records?
- How are your providers selected?
- Does the plan have any restrictions limiting physicians' discussions of treatment options?
- Does the plan have any out-of-network care options?
- Are procedures set up for resolving complaints?
- Is the plan accredited for quality?
To get the names of Medicare managed care plans (HMOs) in your area call 800/638-6833 or web site: http://www.hcfa.gov, and request a free copy of The Medicare Managed Care Directory.
To find out if your plan belongs to the American Association of Health Plans, call 202/778-3200 or web site: http://www.aahp.org.
Do you have questions about...
- How Medicare Works
- Medicare, Supplemental or Long-Term Insurance?
- Health Maintenance Organizations?
If the answer is yes, please call the Health Care Insurance Counseling and Advocacy Program (HICAP).
HICAP staff is available to answer your technical and legal questions, or provide a referral to a HICAP volunteer counselor nearest you.
HICAP offices, located throughout the state, can be reached by calling your local Area Agency on Aging - or you can contact their hotline at 800/434-0222 - or web site: http://www.aging.state.ca.us.
For more information on Medicare, go to our Where We Stand - Medicare Page
Long-Term Care
Long-term care refers to a broad range of health and social services designed to help frail, elderly or functionally-impaired persons maintain a maximum level of physical and psychological well being.
Long-term care service is provided in both institutional and noninstitutional settings.
Institutional Services Are Provided In:
- Residential Care (board & care) Facilities
- Nursing Facilities
Noninstitutional Services Include:
- Home Health Care
- Adult Day Care
- Home Delivered Meals
- Transportation
- In-Home Supportive Services
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