Blue Shield of California 65 Plus HMO Health Insurance for Seniors

Blue Shield of California 65 Plus HMO Health Insurance for Seniors is a great option for those 65 and older who want a comprehensive health plan. It offers a wide range of benefits, including preventive care, hospital stays, and prescription medication coverage.

This plan is designed to meet the unique needs of seniors, with a focus on preventive care to help prevent illnesses and injuries. Preventive care services are covered at 100% with no copayment or coinsurance.

The plan also covers hospital stays, including semi-private rooms, surgery, and other medical services. Additionally, it covers prescription medication, including brand-name and generic medications.

With a network of over 50,000 doctors and hospitals, you'll have access to quality care when you need it. The plan also offers a $0 copayment for primary care physician visits, making it easier to stay on top of your health.

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The Blue Shield of California 65 Plus HMO is designed for Californians aged 65 and older.

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This plan is a type of health maintenance organization (HMO) that offers a range of benefits, including doctor visits, hospital stays, and prescription drugs.

You must reside in a Blue Shield of California HMO service area to be eligible for this plan.

To be eligible, you must also enroll within a certain timeframe, typically during your initial Medicare enrollment period or during the annual Open Enrollment Period.

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To be eligible for this plan, you need to be a California resident who has both Medicare Part A and Part B. You must also live in our geographic plan service area.

You can be a United States citizen or be lawfully present in the United States. This is a requirement for eligibility.

Unfortunately, this plan is closed to new enrollments in 2025. If you're interested in enrolling, you'll need to do so before then.

The plan doesn't discriminate against anyone based on certain factors. These factors include race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.

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The Blue Shield 65 Plus (HMO) plan offers coverage and cost-sharing that's worth understanding.

This plan is insured by Blue Shield of California, a reputable health insurance provider.

The health plan deductible is $0, which means you won't have to pay anything out-of-pocket before your coverage kicks in.

The Maximum Out-of-Pocket (MOOP) for in-network care is $3,600, which is the maximum amount you'll pay for healthcare expenses within a year.

Drugs are covered under this plan, which is a big plus for those with ongoing medication needs.

Here's a quick summary of the plan's key features:

It's essential to understand these details to make an informed decision about your healthcare coverage.

Your Part B premium may differ based on factors including late enrollment, income, and disability status. You'll pay $185.00 for Part B.

You may also qualify for “Extra Help” on drug costs, which can help lower the cost of prescription drugs.

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

Here are the drug costs for Blue Shield 65 Plus (HMO):

Let's break down the costs associated with your Medicare coverage. Your Part B premium may differ based on factors including late enrollment, income, and disability status.

The premium for Part B is $185.00, which is a significant cost to consider.

You'll also pay a premium for Part C, which is $50.40. This is in addition to the Part B premium.

Additionally, you'll pay a small premium for Part D, which is $3.60. This premium is for prescription medication coverage.

If you qualify for "Extra Help" on drug costs, you may be eligible for a reduction in your Part D premium. However, this is not included in the initial breakdown.

Here's a summary of the costs:

The Blue Shield 65 Plus (HMO) plan has a drug deductible of $0.00, which means you don't have to pay anything upfront for your prescription medications.

The plan's drug out-of-pocket maximum is $2,000.00, so you won't have to pay more than this amount for your prescription drugs throughout the year.

The Low-Income Subsidy (LIS) can help you lower the cost of prescription drugs, also known as "Extra Help."

Here's a breakdown of the plan's drug cost-sharing:

The Blue Shield of California 65 Plus HMO plan has two coverage phases: the Initial Coverage Phase and the Catastrophic Coverage Phase.

In the Initial Coverage Phase, you'll pay a maximum of $6,350 out-of-pocket for covered medical expenses before the plan begins to cover 100% of eligible costs.

You'll be responsible for paying a $1,000 deductible during the Initial Coverage Phase.

The Initial Coverage Phase ends when you've paid $6,350 in out-of-pocket costs or reached the end of the calendar year, whichever comes first.

The Catastrophic Coverage Phase kicks in when you've reached the maximum out-of-pocket limit of $6,350.

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