California Medicare Supplemental Insurance Overview
Supplemental health insurance companies in California can offer up to all 12 of Medigap's standardized insurance policies for seniors (referred to by letters A through L). A standardized policy is one that dispenses exactly the same benefits as other benefit packages of the same letter, regardless of which supplemental health insurance company you use.
You may choose to purchase a high-deductible option on your plan. In this case, your Medigap policy will pay for your supplemental health insurance costs only after you've reached the annual deductible ($1,900 in 2008). The Medigap deductible rate increases every year.
Insurance companies in California are regulated by the California Department of Insurance. Medicare SELECT plans, which are a combination of managed care plans and Medigap policies, are regulated by the Department of Managed Health Care. Medigap plans for seniors in California are legitimately sold through only three mediums: 1) sponsoring groups, 2) licensed insurance agents, 3) or by mail. While certain retiree and union plans may offer similar Medicare supplemental benefits to those offered by Medigap insurance policies, they are not affiliated with the standardized and carefully-regulated Medigap.
Most Medi-Cal members with full benefits will find their supplemental health insurance needs covered by their Medi-Cal policies, and do not require a Medigap policy in addition. It is also illegal for health insurance companies in California to sell Medigap policies to most members of Medi-Cal.
However, if you are already a Medigap policy holder when your eligibility for Medi-Cal begins, you can keep your Medigap policy for the purpose of using health care providers not covered under your Medi-Cal plan. Alternatively, you can put your Medigap policy on hold for up to 24 months. Medi-Cal members with a share-of-cost (SOC) plan have the option to purchase a Medigap policy in addition.
Medigap Supplemental Health Insurance for Seniors Policies A-J in California
The following basic benefits must be offered in all Medigap policies A-J:
- The first three pints of blood in each calendar year, unless that blood is replaced.
- The total cost of in-hospital care beyond the standard 150 days covered by Medicare, until a maximum of 365 lifetime days.
- Co-insurance for days 61-90 in the hospital ($265 per day in 2008), as well as co-insurance for your 60 lifetime reserve days.
- Co-insurance benefits of 20% for charged approved by Medicare after Medicare's Part B annual deductible of $135 has been reached.
Medigap Plan A offers only these basic benefits. Medigap Plans B through J offer additional benefits to those listed here.
Medicare Insurance by State
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