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Below form is for California only

left corner SAVE MONEY AND PROTECT YOURSELF FROM LARGE EXPENSES
WITH MEDICARE SUPPLEMENT INSURANCE PLANS

(877)566-5454 Toll Free
Medical Care 2018 Out-of-Pocket costs with
Original Medicare Only
Out-of-Pocket costs with Blue Shield
Medicare Supplement Plan F
Medicare Part A deductible for
15 days hospitalization
      $1,340          $0
Medicare Part A coinsurance for
22 days Skilled Nursing Facility
         $335          $0
Medicare Part B deductible          $183          $0
Medicare Part B coinsurance for surgical
services, supplies, lab tests and therapy
      $2,400          $0
Medicare Part B Excess amounts above what
provider has agreed to accept based on Medicare's approved amount
         $670          $0
YOUR TOTAL OUT-OF-POCKET COSTS       $4,928          $0

Your cost will vary with other Medicare Supplement Insurance plans.

WHY BUY A BLUE SHIELD MEDICARE SUPPLEMENT (MEDIGAP) INSURANCE PLAN? Medicare Supplement (Medigap) plans help pay for healthcare costs that Original Medicare doesn't cover (like copayments, coinsurance and deductibles).

PLUS you can go to ANY doctor or specialist who accepts Medicare anywhere in the U.S. - you're not limited to an HMO provider network. To help control these costs, we offer these supplement plans to suit your personal needs.

MEDICARE PPO SUPPLEMENTAL COVERAGE CHART
(Freedom to use the doctor and hospital of your choice)
BENEFITS Medicare does not pay in 2016
A
C
D
F
F ¹
High Deductible
K
N ²
Medicare Part A
Hospital Services
Part A Deductible ($1,288)  
Hospice Care
365 Additional Hospital Days
Skilled Nursing Facility (SNF) Coinsurance  
3 Pints of Unreplaced Blood
Medicare Part B
Physician and Medical Services
Part B Annual Deductible ($166)        
Part B Coinsurance
Part B Excess Charges at 100%          
Additional Services
Foreign Travel Emergency    
SilverSneakers Fitness Program

¹ Plan F High Deductible has a $2,240 annual plan deductible. Benefits do not begin until out-of-pocket expenses exceed $2,240. These expenses include the Medicare deductibles for Part A and Part B.
² Plan N pays 100% Part B coinsurance except up to $20 copayment for office visit, and up to $50 copayment for ER.


Blue Shield of California medicare supplement plans Health Insurance pic  Download Your Outline of Coverage  Blue Shield of California medicare supplement plans Health Insurance pic

PRINT & MAIL Application - Blue Shield of CA Senior Classics Application

DOWNLOAD YOUR BLUE SHIELD EASY PAY APPLICATION

Download a "Choosing a Medigap Policy" Brochure

Download a "Medicare & you" Brochure

Download a "Your Medicare Benefits" Brochure

Download a "Understanding Medicare Enrollment Periods" Brochure

Download a "Medicare Coverage Outside the United States"

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Medicare Supplement Plans insurance girl wearing glasses
Fill in this form to have your Brochure with Pricing & Application for your Blue Shield of California Medicare Supplement Plan Health Insurance mailed to you.   Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).
Customer Information
Full Name
E-mail
Street Address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Our Ages   My Age or DOB       Spouse's Age  
People Covered
Type of Enrollment

Have you any comments or special instructions?

 

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INITIAL ENROLLMENT PERIOD AT AGE 65:

Turning 65? A one-time-only seven month period, starting three months before you turn 65, when you can buy any Medigap policy you want that is sold in your state. It starts in the first month that you are covered under Medicare Part B and you are age 65 or older. During this period, you canít be denied coverage or charged more due to past or present health problems. If you enroll during this time, the insurance company cannot:

  • deny you medigap coverage or make you wait for coverage to start; or
  • charge you more for a policy because of past or present health problems.
If you purchase a Medigap (or Medicare Advantage) policy after this seven-month initial enrollment period, you could be denied the Medigap (or Medicare Advantage) policy of your choice, or any Medigap (or Medicare Advantage) policy, because of pre-existing health conditions.

ENROLLMENT PERIOD AT AGES YOUNGER THAN 65:

In California, if you are younger than 65 years of age and entitled to Medicare because of a disability, you have an Open Enrollment period. This period is for six months after you first sign up for Medicare Part B. (However, this right does NOT apply to people who have permanent kidney failure known as End Stage Renal Disease or ESRD.) If you receive a notice from a government agency that your Medicare benefits began some time ago, then your Open Enrollment period begins on the date of that federal notice. It is a good idea to apply for a Medigap policy early so it will take effect on the same day as your Part B benefits.

ANNUAL ELECTION PERIOD (AEP):

You can only disenroll or switch plans once per year during the Annual Election Period (AEP) (October 15 - December 7 of each year for benefits that begin the following January). If you want to change your Advantage plan or Part D plan, you can submit an application for a new plan during this period. Your new coverage would begin on January 1.

EXCEPTIONS:

TRIAL RIGHT #1:

You joined a Medicare Advantage (MA) plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare at age 65, and within the first year of joining, you decide you want to switch to Original Medicare. You have the Right to buy any Medigap policy that is sold in your state by any insurance company.
Note: You can/must apply for a Medigap policy as early as 60 calendar days before the date your coverage will end, but no later that 63 calendar days after your coverage ends. If you were previously in an MA plan or PACE organization, you are not eligible for this guaranteed-issue right.

TRIAL RIGHT #2:

You dropped a Medigap policy to join a Medicare Advantage (MA) plan for the first time; you have been in the plan less than a year, and you want to switch back. You have the Right to buy the Medigap policy you had before you joined the MA plan, if the same insurance company you had before still sells it. If your former Medigap policy isn't available, you can buy a Medigap plan A, B, C, F, K, or L that is sold in your state by any insurance company.
Note: You can/must apply for a Medigap policy as early as 60 calendar days before the date your coverage will end, but no later that 63 calendar days after your coverage ends. If you were previously in an MA plan, PACE organization, Medicare SELECT plan or any other health care organization contracting with Medicare, you are not eligible for this guaranteed-issue right.

CALIFORNIA BIRTHDAY RULE:

If a person already has a Medigap (supplement) insurance, they have 30 days of "open enrollment" following their birthday each year when they may buy a new Medigap policy without medical underwriting or a new waiting period. The new policy must have the same or lesser benefits as the old policy. This rule is only for Medicare Supplement (Medigap) policies. Medicare Advantage plans (HMO & PPO) have different rules that apply to their open enrollment options.

CA Insurance Code ß10192.11 (h) - (1) An individual shall be entitled to an annual open enrollment period lasting 30 days or more, commencing with the individual's birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage. During this open enrollment period, no issuer that falls under this provision shall deny or condition the issuance or effectiveness of Medicare supplement coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract. An issuer shall notify a policyholder of his or her rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period.

DISABLED MEMBERS:

Disabled members are allowed to downgrade or move to another Pre-65 Medicare Supplement plan with lesser benefits and a lower cost. Changes will be effective on the current policy paid-to-date.

MEDICARE FOREIGN TRAVEL:

Many Medigap plans do provide coverage for foreign travel. Medigap plans C, D, F, G, M & N cover 80 percent of the cost of emergency care abroad during the first two months of a trip with a $250 deductible and up to $50,000 in a lifetime.

If you have Original Medicare, you can travel anywhere in the U.S. and its territories (this includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands) and get the medical care you need from almost any doctor or hospital. Original Medicare does not cover medical care you get outside the country. If you will be traveling to a foreign country and want insurance, click here for HTH Travel Health Insurance.

The only exceptions in which Medicare may cover medical care you get outside of the U.S. are:

  • Medicare will pay for emergency services in Canada if you are traveling a direct route between Alaska and another state.

  • Medicare will pay for medical care you get on a cruise ship if:
    1. The ship is registered to the U.S.;
    2. The doctor is registered with the Coast Guard; and
    3. You get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.

  • Medicare may pay for non-emergency in-patient services in a foreign hospital (and connected physician and ambulance costs), if it is closer to your residence than the nearest U.S. hospital that is available and equipped to treat you medical condition. This may happen if, for example, you live near the border of Mexico or Canada.


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Important Disclaimer:  Answers and comments provided above are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, governmental, or other professional advice. We do not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service, health plan, or service provider mentioned or any opinion expressed in the website.  Replies, comments, or information gathered on Barricks.com  website may not be accurate but are intended to be helpful.


Barricks Insurance Services
276 N El Camino Real #6, Oceanside, CA 92058
Phone:   (760) 433-0300    |   Fax:   (760) 433-0304
Toll-Free 1-877-Look4Life  (1-877-566-5454)

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