David Fluker Insurance Services
Gilroy, CA - Serving California Residents Since 1995
CA License # 0B58920
Health Insurance Medicare Supplements Medicare Advantage Small Business Plans Senior Dental & Vision Plans Life Insurance
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David J. Fluker, Licensed Life & Health Insurance Agent. California State License # 0B58920
Authorized Independent Agent Serving California Residents.
Web Site ©1999 - 2012 by David Fluker - David Fluker Insurance Services. All Rights Reserved.
Authorized Independent Agent Serving California Residents.
Web Site ©1999 - 2012 by David Fluker - David Fluker Insurance Services. All Rights Reserved.
Anthem Blue Cross is an independent licensee of the Blue Cross Association (BCA). The Blue Cross name and symbol are registered service marks of the BCA.
Blue Shield of California Life & Health Insurance Company is an independent licensee of the Blue Shield Association.
Blue Shield of California Life & Health Insurance Company is an independent licensee of the Blue Shield Association.
Health Insurance for California Seniors 65+ on Medicare
Medicare is a health insurance program for people 65 and over (and in some cases under 65). Medicare is the nation's largest health insurance program and covers nearly 40 million Americans.
Medicare is made up of four parts, Part A, Part B, Part C and Part D.
Medicare is made up of four parts, Part A, Part B, Part C and Part D.
Medicare Part A
Medicare Part A pays for inpatient hospital, skilled nursing care and some home health care. Most seniors are automatically enrolled in Medicare Part A when they turn 65. For 2012, the Medicare Part A deductible is $1,156.00 for the first 60 days. Cost share in 2012 for days 61-90 is $289.00 per day (you pay) and $566.00 per day (you pay) for 91 days and beyond. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21-100 is $144.55 for 2012.
Medicare Part A is free of premium cost for those who have 40 or more quarters of Medicare-covered employment. Seniors with 30-39 quarters may purchase Part A for $248.00 monthly premium. Seniors with less than 30 quarters or who are otherwise not eligible for premium-free Part A would pay a monthly premium of $451.00 for Medicare Part A.
Medicare Part B
Medicare Part B pays for physician services, outpatient hospital services, certain home health services and durable medical equipment. Part B enrollment is not automatic at age 65 and seniors must elect Part B either when they turn 65 or when they lose employer-sponsored health coverage if they work past age 65 (seniors can elect Medicare Part B even if they are covered under an employer-sponsored plan as an employee or they can choose to defer Part B enrollment). Premium for Medicare Part B for 2012 is $99.90 for most seniors (it can be higher depending on income). Generally the monthly Part B premium will be deducted from a senior's Social Security check automatically. The Medicare Part B deductible for 2012 is $140.00.
Medicare Part C
Medicare Part C is the Medicare Advantage program. Medicare Advantage Plans are private health insurance plans approved by Medicare and are used in place of Original Medicare. Part C plan benefits may not cover less than original Medicare, but may cover more. Premiums for Part C Medicare Advantage Plans can range from $0 per month to over $100 per month. Medicare Advantage Plans often include prescription drug coverage (Part D) and these are referred to as MAPD (Medicare Advantage Prescription Drug) Plans. Medicare Advantage Plans are one of three types of private heatlh plans: HMO, PPO or FFS (fee-for-service). When a senior enrolls in a Medicare Advantage Plan, the carrier's provider network, formulary drug network and any co-pays, deductible and co-insurance are all determined by the health plan, not by Medicare.
In addition to MAPD, there are MA only plans (Medicare Advantage) which do not include the Part D prescription drug benefit. It is very important to remember that a senior may not enroll in a Medicare Advantage (MA only) plan that is an HMO or PPO plan and purchase a stand-alone Part D drug plan. Only the MA FFS plans are allowed to be combined with a stand-along prescription drug (Part D) plan.
Medicare Part D
Medicare Part D is the Medicare Prescription Drug benefit. Part D plans may be purchased as a stand-alone plan to accompany original Medicare, original Medicare plus a Supplement, or an MA FFS plan. Part D plans are available for seniors from a variety of private health insurers as well as the base Part D plan directly from Medicare. Part D drug plans have a deductible, then cost share, then what is referred to a the donut hole (no cost sharing senior pays all) then full coverage. There are many variations between Part D drug plans in terms of how each handles the deductible and cost-sharing. Additionally, some carriers are offering Part D drug plans in conjunction with specific pharmacy providers such as Walgreens, CVS, Rite Aid and Walmart.
Medicare Supplement
A Medicare Supplement is a private plan also known as a Medi-gap plan. Supplements are standardized and identified by letter (A-N). Some Medicare Supplement plans were eliminated as redundant with the Medicare Modernization Act. Each Medicare Supplement plan (by letter) has a different level of gap coverage and the plans are intended to help fill the gaps (costs to seniors) in original Medicare. Because Medicare Supplements are standardized, each Supplement of a certain letter (for example: Plan F) must offer identical gap coverage. Medicare Supplements charge a monthly premium and pay gaps after Medicare pays it's portion of cost for covered services.
Medicare Resources for Seniors
Medicare.gov (the Medicare web site is the best single source of Medicare information online)
Medicare & You 2012 Handbook
Choosing a Medigap Policy 2012
Medicare Part A pays for inpatient hospital, skilled nursing care and some home health care. Most seniors are automatically enrolled in Medicare Part A when they turn 65. For 2012, the Medicare Part A deductible is $1,156.00 for the first 60 days. Cost share in 2012 for days 61-90 is $289.00 per day (you pay) and $566.00 per day (you pay) for 91 days and beyond. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21-100 is $144.55 for 2012.
Medicare Part A is free of premium cost for those who have 40 or more quarters of Medicare-covered employment. Seniors with 30-39 quarters may purchase Part A for $248.00 monthly premium. Seniors with less than 30 quarters or who are otherwise not eligible for premium-free Part A would pay a monthly premium of $451.00 for Medicare Part A.
Medicare Part B
Medicare Part B pays for physician services, outpatient hospital services, certain home health services and durable medical equipment. Part B enrollment is not automatic at age 65 and seniors must elect Part B either when they turn 65 or when they lose employer-sponsored health coverage if they work past age 65 (seniors can elect Medicare Part B even if they are covered under an employer-sponsored plan as an employee or they can choose to defer Part B enrollment). Premium for Medicare Part B for 2012 is $99.90 for most seniors (it can be higher depending on income). Generally the monthly Part B premium will be deducted from a senior's Social Security check automatically. The Medicare Part B deductible for 2012 is $140.00.
Medicare Part C
Medicare Part C is the Medicare Advantage program. Medicare Advantage Plans are private health insurance plans approved by Medicare and are used in place of Original Medicare. Part C plan benefits may not cover less than original Medicare, but may cover more. Premiums for Part C Medicare Advantage Plans can range from $0 per month to over $100 per month. Medicare Advantage Plans often include prescription drug coverage (Part D) and these are referred to as MAPD (Medicare Advantage Prescription Drug) Plans. Medicare Advantage Plans are one of three types of private heatlh plans: HMO, PPO or FFS (fee-for-service). When a senior enrolls in a Medicare Advantage Plan, the carrier's provider network, formulary drug network and any co-pays, deductible and co-insurance are all determined by the health plan, not by Medicare.
In addition to MAPD, there are MA only plans (Medicare Advantage) which do not include the Part D prescription drug benefit. It is very important to remember that a senior may not enroll in a Medicare Advantage (MA only) plan that is an HMO or PPO plan and purchase a stand-alone Part D drug plan. Only the MA FFS plans are allowed to be combined with a stand-along prescription drug (Part D) plan.
Medicare Part D
Medicare Part D is the Medicare Prescription Drug benefit. Part D plans may be purchased as a stand-alone plan to accompany original Medicare, original Medicare plus a Supplement, or an MA FFS plan. Part D plans are available for seniors from a variety of private health insurers as well as the base Part D plan directly from Medicare. Part D drug plans have a deductible, then cost share, then what is referred to a the donut hole (no cost sharing senior pays all) then full coverage. There are many variations between Part D drug plans in terms of how each handles the deductible and cost-sharing. Additionally, some carriers are offering Part D drug plans in conjunction with specific pharmacy providers such as Walgreens, CVS, Rite Aid and Walmart.
Medicare Supplement
A Medicare Supplement is a private plan also known as a Medi-gap plan. Supplements are standardized and identified by letter (A-N). Some Medicare Supplement plans were eliminated as redundant with the Medicare Modernization Act. Each Medicare Supplement plan (by letter) has a different level of gap coverage and the plans are intended to help fill the gaps (costs to seniors) in original Medicare. Because Medicare Supplements are standardized, each Supplement of a certain letter (for example: Plan F) must offer identical gap coverage. Medicare Supplements charge a monthly premium and pay gaps after Medicare pays it's portion of cost for covered services.
Medicare Resources for Seniors
Medicare.gov (the Medicare web site is the best single source of Medicare information online)
Medicare & You 2012 Handbook
Choosing a Medigap Policy 2012
800-509-0659
408-847-6139
408-847-6139
Authorized Independent Agent
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