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Medi-Cal

Original post made by Daughter, Midtown, on Nov 19, 2007

My mother turned 65 last month. She currently has BlueCross insurance (we pay for it). BlueCross kindly increased her premium promptly :)

My mother's friends do not seem to be too happy with Medi-Cal. As a result my mom is not too keen on going to Medi-Cal .. I am trying to find out more information !

Is it worth keeping the BlueCross .. its an expensive affair, but is it worth paying the monthly premium if the Medi-Cal is not going to suffice?

Comments (10)

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Posted by Mary
a resident of Duveneck/St. Francis
on Nov 19, 2007 at 9:58 pm

Do you mean MediCARE or MediCAL? There's a big difference. Citizens are eligible for MediCARE at age sixty-five. Most private insurance companies e.g. Blue Cross become the secondary insurance to MediCARE and will not pay anything after age sixty-five unless the insured carries Medicare first. Medicare pays 80% of the Medicare Allowed amount. then the insured pays the other 20%. If a provider 'accepts Medicare assignment", then Medicare specifies what the provider (like the Palo Alto Medical Clinic or Stanford) can charge - and it's much lower than the 'retail price' of the service. THEN after a yearly deductible (which I think this year is $200) , Medicare pays 80% and the insured or his/her secondary insurance e.g. Blue Cross pays all or part of the rest. Your mother can get insurance counseling at Avenidas Senior Center downtown.

MediCal is for the disabled, low income, and various other qualifications. It is a state-subsidized insurance propgram., Medicare is Federal.


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Posted by RS
a resident of Duveneck/St. Francis
on Nov 19, 2007 at 11:44 pm

I think Medi-Cal looks to be reimbursed from the estate of the patient, so good estate planning is important


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Posted by trudy
a resident of Crescent Park
on Nov 20, 2007 at 4:45 am

I'm about to turn 65 this year, and my brain has been frying trying to understand how Medicare will work with my hp retiree insurance. I've moved out of Palo Alto, so am not near Avenidas. The printed info from Medicare and HP is not helpful. "Medicare and You" seems to assume the reader already knows a great deal, instead of knowing zero.

It looks like the doctors get stiffed, getting a very low reimbursement. Certainly there are numerous doctors in my area who do not take Medicare patients.

Is there a way for the patient to provide an extra payment to the doctor? So far I am heating No. That would seem that the only way to get good medical care and have your doctor treated fairly is for the patient to pay the entire amount, going in as if they had no insurance... Yikes.


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Posted by common sense
a resident of Midtown
on Nov 20, 2007 at 5:45 am

If you are 65 or older you should be covered by Medicare. I get my mom a "supplemental insurance policy" from Blue Cross, which will cover the deductible expenses, and if the doctor/hospital charges more than what Medicare covers. Blue Cross offers different types of supplemental insurance, so you can see which policy works best for your situation.


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Posted by Leslie
a resident of South of Midtown
on Nov 20, 2007 at 6:20 am

If you have turned 65 and you are a recipient of Medicare, it is advisable to get supplemental medical insurance. However, there are many different supplemental insurances offered at many different prices.

When I was 65 I really shopped around to get the best and most reasonable supplemental insurance. I have an HMO through Healthnet which allows me to go to a PAMF physician and covers my Part D drug plan.

If you want a PPO which will allow you to go to any Doctor of your choice you will pay much higher premiums. Kaiser also offers good HMO plans for Seniors.




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Posted by Joan
a resident of Midtown
on Nov 20, 2007 at 6:30 am

Trudy, there are many Doctors around who are no longer affiliated with insurance plans and offer private coverage for a fee usually around $300 - $400 per month.


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Posted by Daughter
a resident of Midtown
on Nov 20, 2007 at 8:12 am

I am specifically referring to Medi-Cal. My mother is not a USA citizen.

The question that we are faced with is: Is it worth going the Medi-Cal route when we have a private insurance. Yes, its costs an arm & leg per month, but my concern is the limited coverage/not getting to good doctors due to the reimbursement problems as time goes by.


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Posted by Mary
a resident of Duveneck/St. Francis
on Nov 20, 2007 at 8:48 am

Trudy, MOST if not all company retiree insurance plans stipulate that the retiree MUST have Medicare and then the company retiree insurance is SECONDARY or supplemental. It's really easy. The H-P insurance will - or should - set up what is known as 'Medicare crossover" and Medicare automatically sends the bill to your H-P insurance. (if they don't, then you handle the paper work after Medicare pays.)
Here's how it works. You go to an MD or hospital that accepts Medicare. Virtually all hospitals do. That 'provider' sends the bill to federal Medicare which has offices in different parts of the country. There is Medicare Part A and Medicare Part B - plus Medicare Part D (drugs) if you need it. Part A is for hospital charges, Part B is for MD's, lab work, etc. Take BOTH. Many company retiree insurance programs have a prescription coverage so you don't need Part D.
(and for legal purposes if you don't need Part D which is expensive,you'll get a letter from HP saying you don't need Part D.)

There is a 'deductible' for Part A - hospitals - which this year is about $900. Your 'secondary" e.g. H-P insurance may help pay that. There is a $200 deductible this year for Part D. Those are PER YEAR. Once again, your supplemental insurance, from wherever, may pay that.
Your reteiree company benefits office should be able to help you .

Please ask your retiree benefits office if its retiree insurance is in effect if you don't have Medicare. I'll bet it doesn't. This is really all very easy. We've been doing it for 23 years.

I have HealthNet Seniority Plus retiree insurance through my company. I pay no premiums and $20.00 per office visit co-pay. $10 for generic Rx's. I signed over my Medicare coverage to HealthNet Seniority Plus which is a MEDICARE CHOICE plan. Other than my co-pays, I never see a bill and I am covered anywhere in the country for emergencies - out of country too. I know this is a good deal.
The Palo Alto Clinic offers HealthNet Seniority Plus for monthly premium for those who have no company retiree insurance --- which is getting more more common. E.g. one big huge company went bankrupt and cancelled the retiree insurance for it's long ago retired employees including surviving widows.
The Clinic and other facilities and senior centers offer on-site insurance counseling. Also remember that you will continue to pay the montly Medicare premiums out of your Social Security check. It was $50 a month when I retired fourteen years ago. Now it will be almost $100.00 a month this year. Neither my husband nor I could have our company retiree supplemental insurance IF we did not have Medicare FIRST.


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Posted by huh?
a resident of Midtown
on Nov 20, 2007 at 9:06 am

You mean Medi-Cal ( our taxes) pays for health care to non-citizens? When did this happen? Or is it only for non-citizens who worked in the US and paid taxes as a legal resident?


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Posted by trudy
a resident of Crescent Park
on Nov 21, 2007 at 1:55 pm

Mary, thanks very much for that lucid explanation. It is a big help.

The last time I called HP HR, I got a call back from someone in India, whom I could hardly understand. Woe :-( And I thought it was bad that tech support was outsourced.


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