”Whether you are looking for a change or are new to Medicare, this guide gives you clear information and helpful checklists.
You deserve clarity and confidence when it comes to your healthcare choices. That’s why we are committed to making Medicare enrollment simple and stress-free for you.
Contact us with any questions, large or small!Yours truly,
Your CCHP Medicare Specialists
Let's Start with the Basics:
What is Medicare?
Medicare is a federal program that provides health insurance primarily for people 65 and older, and some people younger than 65 who may qualify due to certain disabilities.
It has four main parts: A, B, C and D.
Provides inpatient coverage like hospitalization
- Included in Original Medicare
- Free for most people who qualify
Provides outpatient/medical coverage like doctor visits
- Included in Original Medicare
- You pay a monthly premium
Part A & B cover only 80% of medical costs and do not include Part D prescription drug coverage.
Medicare Advantage Plans
An “all in one” alternative to Original Medicare offered by private health plans like CCHP. They include:
- Part A
- Part B
Plans can include:
- Part D
- Extra Benefits
With CCHP Medicare Advantage Plans, you’ll get Part D prescription coverage, as well as extra perks including vision, hearing, and dental benefits, and even a monthly allowance to purchase groceries.
Prescription Drug Coverage
Not included in Original Medicare. Purchased through private insurance.
- All CCHP Medicare plans offer prescription drug coverage
Medicare Supplement / Medigap
Optional policy to cover your portion of out-of-pocket expenses if choosing to stay in Original Medicare.
- Offered by private insurance companies
- Often at high monthly premiums
Original Medicare Vs. Medicare Advantage
Original Medicare doesn’t cover all the care you need, such as dental, vision, prescription medications, and more. In fact, Original Medicare only covers about 80% of your medical cost. We are here to help you get the coverage you need. Check out this comparison chart to understand what you get and don’t get with each option.
Part A & B
Prescription drug coverage is not included.
You pay for the Part B premium.
Includes hospital and medical coverage only, covering only 80% of medical costs and not including Part D prescription drug coverage.
Original Medicare does not cover any supplemental benefit. That’s why many people choose Part C Medicare Advantage.
Original Medicare does not offer any extra perks.
There’s no limit to how much you have to pay for your care.
CCHP Medicare Advantage
Covers Part A, B, C, D and more.
CCHP plans start at $0 monthly premium. Members continue to pay for the same Medicare Part B premium.
CCHP plans cover what Original Medicare covers, plus prescription drug coverage and other supplemental benefits.
At CCHP, we offer dental, vision, hearing coverage, acupuncture, and more.
CCHP plans include transportation services to and from your medical appointments. Some CCHP plans also include allowances for groceries to buy healthy foods and Over-The-Counter (OTC) non-prescription health and medical supplies.
All CCHP plans have a maximum limit to how much you have to pay yearly. You won’t have to pay for covered services once you reach your limit.
Medicare Eligibility Checklist
Here is an outline of the basic eligibility requirements for enrolling in the Medicare program. If you think you qualify, you can follow the Enrollment Checklist to transition your care into Medicare.
It is important to note that this checklist provides a general overview of eligibility requirements for Medicare. There may be additional factors and specific circumstances that can affect eligibility, contact CCHP Medicare Specialists for more details.
- You must be at least 65 years old. However, individuals under 65 with certain disabilities or specific medical conditions may also qualify.
- You must be a U.S. citizen or a legal resident who has lived in the U.S. continuously for at least 5 years.
- To qualify for premium-free Part A. You are eligible for premium-free Part A if you or your spouse have paid Medicare taxes for at least 10 years (40 quarters) while working.
Medicare Pre-Enrollment Checklist
Now that you know what Medicare is and the options available to you, it’s time to enroll! Don’t wait too long or you might get hit with pesky penalties. But no worries, we’ve got your back. Just follow this checklist and you’ll be cruising into Medicare without any stress.
7-9 months before you turn 65
6 months before you turn 65.
3 months after you turn 65.
3 months before you turn 65.
Your 65th Birthday month.
Effect on Current Coverage. If you are currently enrolled in a Medicare Advantage plan, your current Medicare Advantage healthcare coverage will end once your new Medicare Advantage coverage starts. If you have Tricare, your coverage may be affected once your new Medicare Advantage coverage starts. Please contact Tricare for more information. If you have a Medigap plan, once your Medicare Advantage coverage starts, you may want to drop your Medigap policy because you will be paying for coverage you cannot use.
Frequently Asked Questions
Medicare is a health insurance program for people age 65 or older. Some younger people with certain disabilities and medical conditions like End-Stage Renal Disease (ESRD) are also eligible.
When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are two main ways to get Medicare:
Original Medicare (Part A & B):
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- Original Medicare covers only about 80% of medical costs. You are responsible for the remaining 20%.
- If you want drug coverage, you can join a separate Medicare drug plan (Part D).
- For extra cost, you can also buy Supplemental or Medigap coverage to help pay for the 20% of medical costs that Medicare doesn’t cover.
Medicare Advantage (Part C):
- Medicare Advantage is an all-in-one alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
- Plans generally have lower out-of-pocket costs than Original Medicare.
- In many cases, you’ll need to use doctors who are in the plan’s network.
- Most plans offer extra benefits that Original Medicare doesn’t cover like vision, hearing, dental, and more.
- Most plans include Part D prescription drug coverage.
When you turn 65, you are automatically enrolled in Original Medicare if you receive Social Security retirement or Railroad Retirement benefits. If you are not automatically enrolled, you can sign up during your Initial Enrollment Period (IEP). IEP begins three months before your 65th birthday, during your birthday month, and then continues for three months after your birthday. For example, if your birthday is in May, your IEP is from February to August.
If you already get Social Security benefits, you will be automatically enrolled in Original Medicare (Part A and Part B) when you become eligible. If you don’t get Social Security benefits and are not ready to apply for them yet, you can visit Social Security’s website or call Social Security’s office at 1-800-772-1213 (TTY 1-800-325-0778) (Mon – Fri, 8 a.m. – 7 p.m.) to apply for Medicare when you become eligible.
You are eligible to enroll in a Medicare Advantage plan, such as the ones offered by CCHP, as long as you have Medicare Parts A & B, and live in the plan’s service area.
Initial Enrollment Period (IEP)
Begins three months before your 65th birthday, during your birthday month, and then continues for three months after your birthday.
Annual Enrollment Period (AEP)
From October 15th to December 7th every year. This is when you can change plans or enroll in a Medicare Advantage plan if you missed the chance to enroll during your IEP.
Special Enrollment Period (SEP)
If you experience a qualifying life event, you have a 60-day period (known as SEP) to sign up for a plan.
CCHP has great Medicare Advantage options for your health coverage needs. We are committed to serving our members with our expansive choice of providers and access to top local hospitals.
San Francisco & San Mateo County residents with Original Medicare (Part A & Part B) can join CCHP Medicare Advantage plans. Contact our Medicare Enrollment Specialists for enrollment assistance by calling 1-888-749-5029 or sending an email to [email protected].
Each part can have late enrollment penalties for premiums if you don’t sign up for Medicare during your Initial Enrollment Period (IEP).
Part A: The penalty is 10% if you are required to pay a Part A premium, to be paid twice the number of years you were eligible for Part A but did not enroll.
Part B: The penalty is a 10% increase on the Part B premium for each full 12-month period that did not enroll but was eligible. This is a lifelong penalty.
Part D: The penalty is 1% of the average monthly prescription drug premium times the number of months late, rounded to the nearest 10 cents. The penalty is generally put in place if you’re not enrolled within 3 months of Medicare Part A or Part B.
To understand the Medicare enrollment penalties, visit Medicare’s website.
For generations, it has been CCHP’s mission to improve our community’s health by providing high-quality, affordable healthcare. Our members’ health, wellness, and safety are our priority. That’s why all CCHP plans, including Medicare Advantage, offer preventive care services and fitness classes at no extra cost. Most of our Medicare plans even provide incentives to help members purchase healthy foods. Members have access to care through our ever-expanding provider network and choices of top local hospitals.
Most of CCHP’s Medicare Advantage plans have a $0 monthly premium based on the level of Extra Help the member receives.
CCHP knows that preventive services to help maintain your health shouldn’t cost extra. That’s why we cover basic services like an annual screening, labs, x-rays, and vaccinations without a copay. In addition, all of our Medicare Advantage plans have a $0 deductible, which means the health services you receive are covered by us from the get-go.
Medi-Cal (also known as Medicaid) is a public health insurance program that provides health coverage to people with low income.
Medicare is a federal health insurance program for people age 65 or older, but some younger people are also eligible.
San Francisco residents who have both Medi-Cal and Medicare may be eligible for extra benefits through CCHP’s Senior Select (HMO D-SNP) Program.