Additional Resources for Medicare Beneficiaries
and Seniors in Contra Costa County
ACA, the Affordable Care Act, and Medicare: FAQs – www.coveredca.com
Question: I am enrolled in Medicare. Do I need to do anything to comply with the ACA?
Answer: No. As a Medicare enrollee, you are not required to do anything to comply with the ACA. You do not need to purchase a new health insurance product or obtain a special identification card. As someone enrolled in Medicare, your coverage under the ACA requirements are already met. You will not face a tax penalty for not having another form of insurance.
Question: Are Medicare benefits being reduced?
Answer: No. In fact, your Medicare coverage has improved as a result of the ACA. Here are some ways how:
1. Free preventive care services. The ACA now provides Medicare enrollees with access to specific preventive medical services at no out-of-pocket cost. These include flu shots, smoking cessation programs, an annual wellness visit for seniors, and screenings for cancer, diabetes and several other chronic diseases.
2. Lower Medicare Part B premiums and deductibles. The Medicare Part B premium in 2012 was lower than projected due to efficiencies introduced by the ACA. In the same year, the Medicare Part B deductible actually decreased – for the first time in Medicare’s history.
3. The prescription drug donut hole is going away. Medicare beneficiaries in the Part D prescription drug coverage gap (known as the “donut hole”) now receive discounts on their brand-name and generic prescription drugs. These discounts will increase each year until the coverage gap is closed completely in 2020. Click here for more information about how the donut hole is being eliminated.
Question: Will I be eligible for government subsidies under the ACA to help pay for my Medicare premiums or medical bills?
Answer: Not in most cases. Medicare enrollees are generally not eligible for ACA subsidies. There could be an exception if someone buys in to Part A because they’re not eligible for free Part A.
Question: Will Medicare Advantage plans go away in 2014?
Answer: No. Private Medicare Advantage plans will still be available in 2014 when the health care reform law takes full effect.
Question: Will Medigap plans still be underwritten in 2014?
Answer: The rules governing the underwriting of Medigap plans – also known as Medicare Supplement plans – are not affected by the ACA. If you apply for a Medigap plan during an open enrollment period, you will not be subject to medical underwriting (or potentially charged more based on your medical history). If you apply for Medigap coverage outside of an open enrollment period, you may be subject to medical underwriting in 2014.
Question: What about Obamacare?
Answer: “Obamacare” isn’t an official title. The official title is the Affordable Care Act, and the official abbreviation is ACA.
Other questions about the ACA? Call Covered California at 1-800-300-1506 or go to www.coveredca.com.
Bay Area Legal Aid – www.BayLegal.org
Bay Area Legal Aid is the largest provider of free civil legal services to low-income residents of the San Francisco Bay Area. If you live in Contra Costa County call the local phone number to find out if you qualify for free legal help: Western Contra Costa County phone 510-250-5270; Central and Eastern Contra Costa County phone 925-219-3325.
California Advocate for Nursing Home Reform – www.canhr.org
California Advocates for Nursing Home Reform (CANHR) fights for the rights of long-term care residents in California. CANHR dedicated to improving the choices, care and quality of life for California’s long term care consumers. Through direct advocacy, community education, legislation and litigation it has been CANHR’s goal to educate and support long term care consumers and advocates regarding the rights and remedies under the law, and to create a united voice for long term care reform and humane alternatives to institutionalization. CANHR has information on their website to help seniors find a nursing home or a residential care / assisted living facility, and information about Medi-Cal programs for long-term care. Phone 1-800-474-1116 or 415-974-5171.
California Department of Health Care Services –
The mission of the Department of Health Care Services (DHCS) is to preserve and improve the health status of all Californians. DHCS works closely with health care professionals, county governments and health plans to provide a health care safety net for California’s low-income and persons with disabilities. For general information phone 1-800-735-2922 or 916-445-4171.
California Department of Insurance –
The California Department of Insurance Senior Information Center includes information about health plans and long-term care insurance including the types of benefits and policies you can buy, both as an individual and as a member of a group, and information on what to consider before purchasing a policy. The site includes links to additional information for seniors including the premium rate history of each company that sells long-term care insurance in California. The CDI can assist with any insurance question, concern, or problem. Phone 1-800-927-4357.
California Genetically Handicapped Persons Program –
The Genetically Handicapped Persons Program (GHPP) is a health care program for adults with certain genetic diseases. The GHPP helps people who are on GHPP with their health care needs. The GHPP works with doctors, nurses, pharmacists, and other members of the health care team in providing many types of health services. Phone 1- 800-639-0597 or 916- 327-0470.
California Health Advocates – www.cahealthadvocates.org/
California Health Advocates (CHA) is a nonprofit dedicated to education and advocacy efforts for California Medicare beneficiaries and the pre-retirement population. CHA promotes the work of the Health Insurance Counseling and Advocacy Program (HICAP) projects and others serving Medicare beneficiaries in California, and provides training and support to local HICAP offices, social and legal services agencies, and other professionals helping people with Medicare. California Health Advocates is a source for up-to-date information on Medicare and Medicare supplement policies, Extra Help and the Low Income Subsidy for paying for prescription drugs, help for people with disabilities, and more. Phone 916-231-5110.
California Health Advocates FAQ on New Medigap Policy Changes – www.cahealthadvocates.org/news/insurance/2009/faq.html
Medigap, also known as Medicare supplemental insurance, is a set of standardized insurance policies that help cover out-of-pocket costs in the Original fee-for-service Medicare program. The current 12 standardized plans will undergo several major changes due to federal legislation passed in 2005. Four of the current plans will be dropped and 2 new plans will be added resulting in a total of 10 standardized plans, the original number mandated by Congress in 1990. The 2005 legislation required states to incorporate all of the required federal changes. California Health Advocates has a FAQ that answers many of the questions about these changes (see the link at the beginning of this article), and links to more information about the Medigap changes.
Note that if you're a California resident with an existing Medigap policy you have a special 30-day open enrollment period each year starting on their birthday to switch your Medigap policie. You can choose a plan from any Medigap insurance company and will have guaranteed issue without medical screening or claims experience. The plan you choose must have the same or fewer benefits as your current Medigap policy.
California Office of the Patient Advocate – www.opa.ca.gov/
The mission of the OPA is to inform and educate consumers about their rights and responsibilities as health plan enrollees and to teach them how to make best use of the services offered by their health plans, and to promote transparency and quality health care by publishing an annual Quality of Care Report Card. Phone 1-888-466-2219.
California Pre-Existing Condition Insurance Plan (PCIP) – www.pcip.ca.gov/Home/default.aspx
The California Pre-Existing Condition Insurance Plan (PCIP) offers health coverage to medically-uninsurable individuals who live in California. The program is available for individuals who have not had health coverage in the 6 months prior to applying. The plan covers inpatient and outpatient care provided by doctors, psychologists, hospitals, laboratories and imaging centers, as well as generic and brand-name drugs. Phone 1-877-428-5060 for more information.
COBRA and Cal-COBRA – www.hmohelp.ca.gov/dmhc_consumer/hp/hp_cobra.aspx
Federal COBRA is a U.S. law that applies to employers and group health plans that cover 20 or more employees. It lets you keep your group health insurance when your job ends or your hours are cut. You have to pay the premium but you can keep your insurance for at least 18 months. Cal-COBRA is a California law that is like Federal COBRA. Cal-COBRA applies to employers and group health plans that cover from 2 to 19 employees. It lets you keep your insurance for up to a total of 36 months. It is also for people who use up their Federal COBRA. When your 18 months of Federal COBRA ends, you can buy 18 more months of health insurance under Cal-COBRA. Phone 1-800-927-4357.
Contra Costa County Adult Protective Services – www.ehsd.org/adult/adult001.html
Every year, thousands of older and dependent adults suffer from abuse, neglect or exploitation. They are living in their own homes, apartments and with their families. Most of them are suffering in silence. Adult Protective Services provides assistance 24-hours a day to elderly and dependent individuals who are victims of physical, emotional or financial harm or abuse. Phone 1-877-839-4347.
Contra Costa County Aging and Adult Services – www.ehsd.org/adult000.html
We assist older adults and people with disabilities to maximize self-sufficiency, safety, and independence. Phone 1-800-510-2020.
Contra Costa County Area Agency on Aging (AAA) – www.ehsd.org/adult/adult014.html
The Mission of the AAA is to provide leadership in addressing issues that relate to older Californians, to develop community-based systems of care that provide services which support independence within California’s interdependent society, and which protects the qualify of life of older adults and persons with functional impairments, and to promote citizen involvement in the planning and delivery of service. See the website or phone 1-800-510-2020 for more information.
Contra Costa County Long-Term Care Ombudsman – www.ccombudsman.org/
Ombudsmen act as advocates for seniors in nursing homes and residential care facilities. We resolve complaints, uphold residents' rights and investigate abuse that occurs in long-term care facilities. Phone 925-685-2070.
Contra Costa County Online 211 Database – www.211database.org
The 211 Database (previously named CORD) has extensive, up-to-date search engine for information on more than 2,500 services for Contra Costa County residents, and is accessible to everyone free of charge.
Contra Costa County Way to Go Transportation Resources Guide –
This guide has been designed to quickly give you the information you need to use the transportation choices available to you in Contra Costa County and the Bay Area. You can use this guide in several ways:
- By Community
- By Transit Provider
- By ADA Paratransit Provider
There is also a reference for 511 Fares, Schedules and Regional Transportation, and a Quick Reference with telephone numbers and website links. Click the link at the top of this entry to download your copy of the Guide. (Adobe Acrobat Reader is required.)
Contra Costa Crisis Center Information Referral – www.crisis-center.org/211_Information_Referral.html
211 is the national, toll-free, three-digit phone number to call 24 hours a day for information about local health and human services. It enables people to find out about vital resources in their community quickly and easily. A Contra Costa Low Cost Medical Resources Guide is available by clicking here. (Adobe Acrobat Reader is required.)
Contra Costa Senior Legal Services – www.volunteercentersbayarea.org/org/1109213.html
Contra Costa Senior Legal Services (SLS) provides free legal services to Contra Costa County seniors who are age 60 or older. SLS provides general legal advice, counsel and representation in civil matters, such as housing, income maintenance/finance, elder abuse, consumer matters, estate planning, and related issues. Western Contra Costa County phone 510-374-3712; Central and Eastern Contra Costa County phone 925-706-4852.
Dental and Vision Resources – Contra Costa HICAP Dental Resources List
This list has been compiled to provide access to information about dental and vision insurance, dental clinics, and dental broker services for seniors and others in Contra Costa County.
Extra Help for Prescription Drugs – A registered HICAP counselor can help you apply for Extra Help for prescription drug coverage. If your annual income does not exceed $16,245 for an individual or $21,855 for a married couple living together, you may qualify for Extra Help. Even if you receive support from others to help pay your expenses, that support is not counted in your income limit. Your resources (bank accounts and other investments) cannot exceed $12,510 for an individual or $25,010 for a married couple living together. Your car, your house, and life insurance policies are not counted as resources. Extra Help can make your prescription drugs affordable. For assistance in applying for Extra Help, contact Contra Costa County HICAP at 1-800-510-2020 or 925-229-8434, or you can contact one of our counseling locations to make an appointment. Follow this link to our counseling locations page.
Food Stamp Program – www.ehsd.org/adult/adult009.html
The Food Stamp Program is a nutrition assistance program in which eligible low-income households can purchase food at participating grocery stores with the use of Electronic Benefit Transfer cards that look like a credit card or bank debit card. At the Federal level, the program is administered by the United States Department of Agriculture’s Food and Nutrition Service. In California, the Food Stamp Program is supervised at the state level by the California Department of Social Services and in Contra Costa County is administered by the County Welfare Department. Phone 1-800-221-5689 for more information or to apply; current Medi-Cal and food stamp recipients can call 1-866-663-3225.
Health Services Advisory Group – www.hsag.com/camedicare/index.asp
Health Services Advisory Group (HSAG) is Medicare’s Quality Improvement Organization (QIO) in California. In that role, HSAG handles quality of care complaints and discharge notice appeals from Medicare members and their designated care givers. The 24-hour, 7-day a week phone number for HSAG is 1-800-841-1602 (or 1-800-881-5980 for TDD-hearing impaired callers).
In-Home Supportive Services – www.dds.ca.gov/SupportSvcs/IHSS.cfm
In-Home Supportive Services (IHSS) provides personal care and domestic services to persons who are aged, blind or disabled and who live in their own homes. IHSS is provided to those who otherwise might be placed in an out-of-home care facility but who can safely remain in their own home if IHSS services are received. The In-Home Supportive Services (IHSS) program is administered by each county with oversight by the California Department of Social Services (CDSS). In Contra Costa County phone 1-800-510-2020.
Kidney Health Care Coverage – www.kidneydrugcoverage.org/index.htm
This site was developed by the Kidney Medicare Drugs Awareness and Education Initiative to provide timely, consistent, reliable, and up-to-date information about Medicare and Medicare Prescription Drug Coverage (Part D), specifically for kidney patients and the healthcare professionals involved in their care.
Legal Assistance for Seniors – www.lashicap.org/about-us
Legal Assistance for Seniors (LAS) is the only legal services program in Alameda and Contra Costa Counties devoted exclusively to assisting the elderly. Since its founding, LAS has served clients at locations throughout Alameda County in addition to its office in Oakland – meeting with groups at senior centers and housing developments for educational presentations and individual assistance, and making home visits to those who cannot travel. In 2000, the agency expanded its service base to include limited legal assistance to HICAP clients in Contra Costa County. We provide free legal advice and information, representation in court and administrative hearings, referrals to other community resources, and community education and training on legal issues.
Legal Assistance for Seniors helps seniors with:
- Preventing Elder Abuse
- Guardianship of Minors
- Income Maintenance
- Health Insurance Counseling and Advocacy Program
- Legal Services for Immigrants
All services are free. Contact us for more information and assistance. Phone 510-832-3040.
Medi-Cal – www.dhcs.ca.gov/services/medi-cal/Pages/MCIndividual.aspx
Medi-Cal is a program that provides health coverage for low-income children, parents, seniors and persons with disabilities. Medi-Cal provides a wide scope of benefits including medical, dental, vision, prescription drug and mental health coverage. Eligibility for Medi-Cal is based on a number of factors; Contra Costa residents can phone 1-877-503-9350 to determine if they qualify and enroll. You can apply online and mail a completed application at www.dhcs.ca.gov/services/medi-cal/Pages/MediCalApplications.aspx.
Medi-Cal Facts for Seniors – We have a Medi-Cal fact sheet for seniors who live in Contra Costa County. Follow this link to our Medi-Cal Facts for Seniors page.
Medicare (CMS – Centers for Medicare & Medicaid Services) – www.medicare.gov
The Official U.S. Government Site for people with Medicare or who will be signing up for Medicare. Phone 1-800-Medicare (1-800-633-4227) 24 hours a day 7 days a week for assistance.
Medicare Part D Prescription Drug Program "Donut Hole" – Many persons covered by Medicare Part D Prescription Drug Plans or Medicare Health Plans have discovered that they now have to pay full price for their prescription drugs. They have entered the "coverage gap" or "donut hole" of their drug coverage. We have compiled a list of ways you can save money on your prescriptions. Follow this link to our Donut Hole information page.
Medicare Part D Prescription Drug Program (Part D) Late Enrollment Penalty – The late enrollment penalty is an amount added to your Part D premium. You may owe a late enrollment penalty if you never signed up for Medicare Part D when you were initially eligible and you did not have other creditable prescription drug coverage, or if, at any time after your initial enrollment period is over, there is a period of 63 or more days in a row when you did not have Part D or other creditable prescription drug coverage.. Follow this link for more information about the Medicare Part D Late Enrollment Penalty.
Medicare preventive benefits – A complete list of preventive benefits provided through Medicare for 2012 are outlined in this chart from The National Council on Aging. (You will need Adobe Acrobat Reader to view the chart.)
Medicare Rights Center – www.medicarerights.org/
The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives. For the hotline phone 1-800-333-4114.
Medicare Rights Center – Health Reform and Medicare
The Medicare Rights Center has published a series of documents defining how the new health care reforms passed by Congress and signed into law by President Obama in March, 2010 will benefit Medicare recipients:
• Get the Facts: Health Reform and Medicare Update: March 2010 –
• Health Reform and Medicare: A Timeline of Implementation –
• Health Reform and Medicare: Closing the Doughnut Hole –
Medicare Screening for HIV Infection – www.medicare.gov/navigation/manage-your-health/preventive-services/hiv-screening.aspx
Medicare will cover annual voluntary screening for HIV infection for people with Medicare of any age who ask for the test, pregnant women up to 3 times during a pregnancy, and people at increased risk for the infection. For more information use the link above to go to the Medicare website or phone 1-800-Medicare (1-800-633-4227) 24 hours a day 7 days a week.
National Council on Aging – www.mymedicarematters.org/
The National Council on Aging (NCOA) website focuses on Medicare Prescription Drug Plans, with sections for those new to Medicare and those who are seeking information to help them decide if they should switch plans. The website also included information about Medicare Basics and Medicare features for staying healthy.
National Council on Aging Better Choices, Better Health™ Free Online Workshop for People with Chronic Conditions – https://selfmanage.org/BetterHealth/SignUp
Nearly half of all adults live with one or more chronic health conditions, such as arthritis, asthma, diabetes, lung disease, heart disease, stroke, and osteoporosis. The NCOA Better Choices, Better Health™ Workshop is the online version of the internationally recognized Chronic Disease Self Management Program (CDSMP), developed and tested at the Stanford University Patient Education Center. Better Choices, Better Health™ is now available in all 50 states for a limited time. Register now to reserve your spot.
National Senior Citizens Law Center – www.nsclc.org/
The National Senior Citizens Law Center advocates before the courts, Congress and federal agencies to promote the independence and well-being of low-income elderly and disabled Americans. Phone 510-663-1055.
Patient Advocate Foundation (PAF) – www.patientadvocate.org/
The Patient Advocate Foundation is a national non-profit organization that seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability relative to their diagnosis of life threatening or debilitating diseases. Phone 1-800-532-5274.
Prescription Drug Information and Assistance
For information about assistance with costs for prescription drugs under Medicare Part D, follow this link to our Donut Hole information page.
Senior Legal Hotline – www.seniorlegalhotline.org/1-what.html
The Senior Legal Hotline exists to provide seniors with fast, accurate advice on any legal subject, by phone and Internet. We aim to empower callers to solve the problems they face, and when needed, we may offer limited extra assistance. Phone 1-800-222-1753.
Social Security Administration (SSA) – www.ssa.gov/
The U.S. Social Security Administration. Apply here for Social Security benefits including Supplemental Security Income (SSI) and disability benefits (SSDI), and to apply for Medicare. Phone 1-800-772-1213. The number for the Walnut Creek Social Security office is 1-877-319-6042.
Stop Medicare Fraud: Senior Medicare Patrol – www.stopmedicarefraud.gov/preventfraud/smp/forthepublic/aboutthesmpprogram/index.html
Protect! Detect! Report! The Senior Medicare Patrol (SMP) is a grassroots network of volunteers who work to educate seniors and other Medicare and Medicaid beneficiaries about how to protect, detect, and report health care fraud. We believe that educating and empowering health care consumers to prevent fraud is an essential strategy for protecting our citizens and their health benefits and strengthening Medicare and Medicaid. Click on the link above to find out how you can help and benefit from this program. Click here for a video explaining benefits of the program.
Veterans Health Administration, Department of Veterans Affairs – www1.va.gov/health/
VA health benefits are open to all Veterans. Family members may also be eligible to receive benefits. Phone 1-800-827-1000.
Priority Group 8 Adds Benefits for Thousands of Veterans - Starting June 15, 2009, more than 260,000 Veterans became eligible for healthcare program enrollment. The change affects Veterans whose incomes exceed the current VA income thresholds by up to 10 percent. Read more about this benefit here and find out if you're eligible using VHA's enrollment calculator.