In California, there are thirteen counties where the Medicare Advantage capitation amount will exceed $1,000 per enrolled member. This does not include any possible bonuses based on quality scores OR for any Part D Prescription drug benefits included in the Medicare Advantage plan. The lowest capitation amount is $841.14 in Imperial County and the highest is $1,158.97 in Inyo County. These figures are from the Medicare RateBook2020 that lists the capitation amounts for all counties in the United States.
Posts related to Medicare Advantage plans which are original Medicare health benefits provided by private companies.
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
You must have been enrolled in a Medicare Advantage medical plan to take advantage of the MA OEP. If you never enrolled in a MA or MA-PD, you can’t join one during the MA OEP. You can’t switch standalone Part D Prescription drug plans during the MA OEP. Additionally, if you go from a MA-PD to a MA plan, you can’t add a standalone Part D Prescription Drug plan. The MA OEP doesn’t apply to Medicare Savings Accounts (MSAs) or Cost Plans.
For eligible members, there is no additional cost to participate in this program or for services provided by Landmark. Covered services provided by non-Landmark providers through a referral from Landmark may be subject to cost-sharing based on members’ health plan benefits and coverage.
This high level overview and will not address every situation that a Medicare beneficiary may find them self in. This short primer is meant help you understand the different parts of Medicare and how they work, or don’t work, together. The following information can also be found in the Medicare and You Handbook.
Anthem Blue Cross of California Medicare Advantage dual eligibility with Medi-Cal Special Needs Plans May 30, 2015 This guidance is generally applicable for all health insurance companies that offer Medicare Advantage Special Needs Plans for dual eligible beneficiaries. Dual Eligibles (Duals) are individuals who are entitled to benefits from both the federal Medicare and state-run […]
Since the beginning of 2015 through April 17th, the Centers for Medicare and Medicaid Services (CMS) have issued over $2 million in penalties on Medicare Advantage plans across the United States. Of the twelve Medicare Advantage plans cited for non-compliance, one had their enrollment activities suspended while the rest were issued civil money penalty. All […]
On October 29th, 2014, Chinese Community Health Plan (CCHP) was notified that they were being put on immediate imposition of intermediate sanctions from the Centers for Medicare & Medicaid Services (CMS). The Medicare sanction was triggered by what the CMS auditors concluded were severe violations in the Chinese Community Health Plan Medicare Advantage (MA-PD) plans offered in […]
The Centers for Medicare and Medicaid released their reimbursements rates for Medicare Advantage plans by each county in the United States. Commonly known as the capitation rate, the table shows what Medicare pays to a private Medicare Advantage plan each month for each beneficiary enrolled in the health plan. The lowest reimbursement is in San […]
A five star Medicare Advantage will be paid $890 in Sacramento County, $947 in San Francisco County, $951 in Los Angeles County and $856 in San Diego County per month by the Centers for Medicare and Medicaid for each enrolled member. The data and calculations that go into determining the monthly reimbursement or capitation rate for Medicare […]