Simplified Health Insurance Services
Affordable, Simplified Health Insurance Plans
 
Medicare Healthcare plans
Medigap Insurance Plans
We offer Medicare Advantage Plans By HealthNet, Aetna
 and for Medicare Supplement Plans a Choice of Multiple Carriers.

Medicare 

Medicare is for people who are 65 and older and for some people under 65 who have a disability.

Medicare has a website to help you choose a Medicare health plan in your county. It compares the monthly premiums and the out-of-pocket expenses and tells you what benefits, such as drugs and vision care, each plan covers. You can also view detailed information about the costs and benefits of each plan. In addition, there is a Health Care Quality Report Card for Physician Groups in California based on Medicare Advantage patients’ clinical records.

Medicare Benefits

  • Part AHospital Coverage  

    Medicare Part A (Hospital Insurance)

    What is Part A (Hospital Insurance)?

    Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

    How Much Does Part A Cost?

    Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called "premium-free Part A."

    If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:

    • You're 65 or older, and you have (or are enrolling in) Part B, and you meet the citizenship or residency requirements.
    • You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)

    In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

  • Part BMedical Insurance  

    Medicare Part B (Medical Insurance)

    What is Part B (Medical Insurance)?

    Part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

    How Much Does Part B Cost?

    If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.

    How Do I Get Part B?

    Some people automatically get Part B.  Learn how and when you can sign up for Part B.

    What Does Part B Cover?

    To find out if Part B covers something specific, visit Your Medicare Coverage. Part B covers two types of services:

    • Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
    • Preventive services — Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
  • Part CMedicare Advantage Plans   

    Medicare Advantage (Part C)

    What is a Medicare Advantage Plan (Part C)? GET A FREE QUOTE

    A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

    If you join a Medicare Advantage Plan, the plan will provide all of yourPart A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most includeMedicare prescription drug coverage (Part D).

    Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

    Different Types of Medicare Advantage Plans

    • Health Maintenance Organization (HMO) Plans
    • Preferred Provider Organization (PPO) Plans
    • Private Fee-for-Service (PFFS) Plans
    • Special Needs Plans (SNP)

    There are other less common types of Medicare Advantage Plans that may be available:

    • HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
    • Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

    How Much Does a Medicare Advantage Plan Cost?

    In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

    • Whether the plan charges a monthly premium.
    • Whether the plan pays any of your monthly Part B premium.
    • Whether the plan has a yearly deductible or any additional deductibles.
    • How much you pay for each visit or service (copayments orcoinsurance).
    • The type of health care services you need and how often you get them.
    • Whether you follow the plan’s rules, like using network providers.
    • Whether you need extra benefits and if the plan charges for them.
    • The plan’s yearly limit on your out-of-pocket costs for all medical services.

    What Does a Medicare Advantage Plan Cover?

    In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

    How to Join a Medicare Advantage Plan

    Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area.  Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan's Web site. Medicare also has information on quality to help you compare plans.

    A Few Extra Things You Should Know about Medicare Advantage Plans

    • You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.
    • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
    • Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
    • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
    • You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
    • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
    • If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.   

      GET FREE QUOTES and COMPARE PLANS

 
  • Part DPrescription Drug Plans  

    Medicare Prescription Drug Coverage (Part D)

    Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty. 

    To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

    • 2 Ways to Get Medicare Drug Coverage
    • When Can You Join a Medicare Drug Plan?
    • How to Join a Medicare Drug Plan
    • How to Switch Your Medicare Drug Plan
    • How to Drop Your Medicare Drug Plan
    • What You Pay for Medicare Drug Coverage
    • Costs in the Part D Coverage Gap
    • What Is the Part D Late Enrollment Penalty?
    • How much is the Part D Penalty?
    • What Part D Plans Cover
    • MTM Programs for Complex Health Needs
    • Drug Plan Coverage Rules
    • Tips For the First Time You Use Your Medicare Drug Coverage
    • Fill a Prescription Before You Get Your Plan Card
    • How Other Insurance & Programs Work With Part D  


      GET A FREE QUOTE and COMPARE PLANS

    2 Ways to Get Medicare Drug Coverage

    There are two ways to get Medicare prescription drug coverage:

    1. Medicare Prescription Drug Plans.These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
    2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

    Both types of plans are called “Medicare drug plans.”  In either case you must live in the service area of the Medicare drug plan you want to join.

    When Can You Join a Medicare Drug Plan?

    • When You First Get Medicare (Initial Enrollment Periods)
    • During Certain Times Each Year (Yearly Enrollment Periods)
    • In Special Circumstances (Special Enrollment Periods)

    How to Join a Medicare Drug Plan

    Once you choose a Medicare drug plan, you may be able to join by:

    • Enrolling on the Medicare Plan Finder or on the plan's Web site
    • Completing a paper application
    • Calling the plan
    • Calling 1-800-MEDICARE

    When you join a Medicare drug plan, you'll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

    Joining a Medicare Drug Plan May Affect Your Medicare Advantage Plan

    If your Medicare Advantage Plan includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

    How to Switch Your Medicare Drug Plan

    You can switch to a new Medicare drug plan simply by joining another drug plan during one of these times. You don't need to cancel your old Medicare drug plan or send them anything. Your old Medicare drug plan coverage will end when your new drug plan begins.

    If you want to join a plan or switch plans, do so as soon as possible so you'll have your membership card when your coverage begins, and you can get your prescriptions filled without delay. You should get a letter from your new Medicare drug plan telling you when your coverage begins.

    Don't give personal information to plans that call you unless you're already a member of the plan.

    How to Drop Your Medicare Drug Plan

    If you want to drop your Medicare drug plan and you don't want to join a new plan, you can do so during one of these times.

    • You can disenroll by calling 1-800-MEDICARE.
    • You can also send a letter to the plan to tell them you want to disenroll.

    If you drop your plan and want to join another Medicare drug plan later, you have to wait for an enrollment period. You may have to pay alate enrollment penalty.

    What You Pay for Medicare Drug Coverage

    You’ll make these payments throughout the year in a Medicare drug plan:

    • Monthly premium
    • Yearly deductible
    • Copayments or coinsurance
    • Costs in the coverage gap
    • Costs if you get Extra Help
    • Costs if you pay a Late Enrollment Penalty

     Your actual drug plan costs will vary depending on:

    • The drugs you use
    • The plan you choose
    • Whether you go to a pharmacy in your plan’s network
    • Whether your drugs are on your plan’s formulary
    • Whether you get Extra Help paying your Part D costs

    Look for specific Medicare drug plan costs, and then call the plans you’re interested in to get more details.

    If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare prescription drug coverage. You may also be able to get help from your state.

    Monthly Premium

    Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium you pay to your plan may include an amount for prescription drug coverage.

    Get Your Premium Automatically Deducted

    Contact your drug plan (not Social Security) if you want your premium deducted from your monthly Social Security payment. Your first deduction will usually take 3 months to start, and 3 months of premiums will likely be deducted at once.

    After that, only one premium will be deducted each month. You may also see a delay in premiums being withheld if you switch plans. If you want to stop premium deductions and get billed directly, contact your drug plan.

    Your Premium Could Be Higher Based on Income

    A small group—fewer than 5% of all people with Medicare—may pay a higher monthly premium for Part D coverage based on their income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare drug coverage.

    If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain limit, you’ll pay an extra amount in addition to your plan premium. Usually, the extra amount will be deducted from your Social Security check.

    Contact Social Security With Questions

    See Social Security’s “Medicare Premiums: Rules for Higher Income Beneficiaries.” Contact Social Security if you have to pay an extra amount and you disagree (for example, you have a life event that lowers your income).

    Yearly Deductible

    This is the amount you must pay each year for your prescriptions before your Medicare drug plan begins to pay its share of your covered drugs. Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $320 in 2012. Some Medicare drug plans don't have a deductible.

    Copayment/Coinsurance

    This is the amount you pay for each of your prescriptions after you have paid the deductible (if your plan has one). Some Medicare drug plans have different levels or "tiers" of coinsurance or copayments, with different costs for different types of drugs.

    • Coinsurance means you pay a percentage of the cost (for example, 25%) of the drug.
    • With a copayment, you pay a set amount (for example, $10) for all drugs on a tier. For example, you may pay a lower copayment for generic drugs than brand-name drugs.

    Costs in the Part D Coverage Gap

    Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.

    Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Also, people with Medicare who get Extra Help paying Part D costs won't enter the coverage gap.

    Once you enter the coverage gap, you get a 50% manufacturer-paid discount on covered brand-name drugs. Although you’ll only pay 50% of the price for that brand-name drug, the entire price will count as out-of-pocket spending, which will help you get out of the coverage gap.