Medicare and Medicare Advantage Plans 2008

• Advantra Freedom 1 & 2

• Aetna Medicare Private Fee for Service Plans

  • Open Value

  • Open Premier

• Blue Cross Freedom Blue PPO

• Blue Cross SmartValue*

• Care Assured/HealthMarkets

• Health Net Pearl (Option 1, 9 & 11)

• Partnership Advantage

• Secure Horizons MedicareDirect

• Sterling Options*

• Today's Options*

• TriCare for Life (Medicare supplement)

• WellCare (Duet, Concert, Prelude & Sonata)

• Medicare Medigap Plans (i.e. AARP)

Additional Medicare plans are being reviewed and will added as approved.  Please check back weekly for updates.

*Please review benefits carefully. Must notify health plan before receiving some services in order to avoid penalties.

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 2008 Plans NOT Accepted (EXCEPT FOR EMERGENCY CARE):

• Health Net Seniority Plus (Green & Ruby)

• Humana Gold Choice

• Kaiser Senior Advantage

 *If you don’t see your plan here and have questions please feel free to contact us at (707) 438-3500. 

Beginning in 2008, Medicare Beneficiaries will have 51 choices of Medicare Advantage plans to chose from.  These plans range from Private Fee-for-Service (PFFS) plans to PPOs and HMOs.  To help understand these plans, we recommend contacting:

Medicare: 1-800-633-4227 (1-800-Medicare) or www.Medicare.gov
or
HICAP: 1-800-434-0222 or www.senioradvocacyservices.org

Here is a very basic description of the differences between the various Medicare Advantage plans offered:

• PFFS: PFFS plans are like old-fashioned indemnity plans in that there is no managed care involved – no authorizations, no contracting, no network requirements.  You may pay more or less for Medicare-covered benefits. You may have extra benefits that Original Medicare Plan doesn't cover.

• HMO: HMO plans you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Your costs may be lower than in the Original Medicare Plan.

• PPO: PPO plans are a type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

• Medicare Supplement (Medigap) Plans: This is not a Medicare Advantage plan.  When you sign up for a Medigap plan, Medicare is the primary payer and the Medigap plan is your secondary insurance. There are 12 standardized plans that are sold by private insurance companies labeled A through L. The monthly premium varies between plans and is dependent on the county where you live and your age. To get a list of companies that sell these plans, call HICAP at 1-800-434-0222 and ask for a list of Medigap plans in your county.

Medicare Part D – Outpatient Prescription Drug Coverage: This is in addition to your Medicare Part A and Part B. If you sign up for a Medicare Part C plan, that plan may or may not include Part D drug coverage. If it doesn’t include it or you have a Medigap plan, you may want to enroll in a Medicare Part D plan to cover your outpatient prescription drugs.

Again, to help understand these plans, we recommend visiting www.Medicare.gov, calling 1-800-633-4227 (1-800-Medicare), or calling HICAP at 1-800-434-0222 or visiting www.senioradvocacyservices.org.

What is HICAP (Health Insurance Counseling and Advocacy Program)?

HICAP, the Health Insurance Counseling and Advocacy Program, was established by the California Department of Aging under 1984 legislation signed by Governor George Deukmejian. The program is designed to provide Medicare beneficiaries and persons 60 years of age and older with assistance in dealing with Medicare, HMOs, long-term care insurance, and other health insurance issues. The North Bay HICAP office assists people living or moving to Lake, Mendocino, Marin, Napa, Solano, and Sonoma Counties.

The success of the HICAP program is achieved through responsible, committed volunteers who want to help others. HICAP's staff and volunteers receive extensive initial training, as well as subsequent training workshops. Once a volunteer counselor has completed the necessary hours to counsel, they are registered with the California Department of Aging. All services are provided free of charge.

HICAP provides two main services -- individual counseling and community education presentations:

HICAP Counseling Services
HICAP relies heavily on its volunteer counselors to provide individual assistance by helping people to:

• Understand Medicare benefits;

• Evaluate options to supplement Medicare;

• Develop a system to organize their medical bills;

• Review and appeal claim denials;

• Explore long-term care options;

• Clarify your rights as a health care consumer.
   

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