Q: I am trying to help an elderly relative pick health care. I am so confused. I have run into Medicare, Medi-Cal, Medicaid, Medigap and Medicare Advantage. Can seniors have only one of these items, or can they have a combination? Can you help me make sense of all of this?
A: Medicare is a nationwide, federally financed health insurance plan for those 65 and older, disabled people who are eligible for Social Security disability benefits and people on dialysis for chronic kidney disease. It is the major health insurance used by seniors and has been in effect since 1965.
The cost of service is billed to the government. This option is one that remains today.
You next mention Medi-Cal and Medicaid, which are basically the same. Medicaid is a federal health care assistance program designed to help pay medical expenses for low-income families. Medi-Cal is California’s version of that federal program.
Medi-Cal is jointly funded by the federal government and the state of California. Each state designs and administers its own program, and it is managed on a county basis. To be eligible for Medi-Cal, applicants must meet residency, age or disability requirements and show financial need.
Medigap insurance is additional coverage bought by many seniors who are covered by original fee-for-service Medicare. Because Medicare does not fully cover health care costs, a Medigap policy covers expenses approved by Medicare but excluded from Medicare’s payment. These policies also offer some additional coverage for items excluded under Medicare.
Medicare Advantage, now known as Senior Advantage, was added to Medicare coverage in the 1980s and gave seniors a choice of how they wanted their coverage provided. Seniors could select fee-for-service Medicare or assign their coverage to an alternate plan. Medicare Advantage plans include HMOs and PPOs.
Someone with fee-for-service Medicare very likely also will have a Medigap policy and also could qualify for Medi-Cal.
A person with an HMO or PPO would not need a Medigap policy but could qualify for Medi-Cal. Those with Medicare and Medi-Cal are called dual-eligible, previously called Medi-Medi.
This is a very simple explanation of a very complicated system. I hope it helps you put the pieces together.
Before enrolling in the Medicare system, you may wish to make an appointment with a counselor from the Health Insurance Counseling Advocacy Program to help you through the maze of options. Call 477-7310 to find a counseling center in your area.
June 24: “What You Don’t Want to Learn the Hard Way When Caring for an Aging Loved One” seminar, 5:30-7 p.m., Senior Concerns Day Care Center, 401 Hodencamp Road, Thousand Oaks. Call 497-0189 for more information and reservations.
June 29: “Take Me to a Million,” based on “Who Wants to Be a Millionaire,” at Goebel Game Day, 2 p.m., Goebel Adult Community Center, 1385 E. Janss Road, Thousand Oaks. Call 381-2744 for information and reservations.