Medicare is a national health insurance program for:
- Most people 65 and older.
- Some younger people with disabilities.
- People with End-Stage Renal Disease (kidney failure requiring dialysis or a transplant).
Medicare Advantage is Medicare's managed care program. If you join Medicare Advantage, you get all your care through an HMO or PPO that has a contract with Medicare.
The Federal Center for Medicare Services (CMS), not the California Department of Managed Health Care (DMHC), regulates Medicare Advantage plans. DMHC conducts initial licensure review and financial oversight on Medicare Advantage plans
Get Help from HICAP
HICAP is the Health Insurance Counseling and Advocacy Program. Anyone who has Medicare can get free help with forms, problems, and questions. Call HICAP at 1-800-434-0222 or visit the HICAP web site.
Medicare Part D
Medicare Part D is the prescription drug program for people with Medicare. You can read more about Medicare Part D.
If You Have a Complaint
You have the right to file a complaint and to appeal a decision your Medicare Advantage health plan makes about your care.
- For help filing a complaint or an appeal, call HICAP at 1-800-434-0222.
- For certain kinds of problems, call Health Services Advisory Group (HSAG). HSAG can help protect your Medicare rights. Call HSAG if:
- You have a complaint about the quality of your care.
- You are being sent home from the hospital too soon,
- Your home health care, nursing home care, hospice care or comprehensive outpatient rehabilitation therapy is ending too soon.
- For problems about denied care or services, other than discharge from the hospital, nursing home or other rehabiliatiatve program, contact MAXIMUS Federal Services at:
MAXIMUS Federal Services
Eastgate Square
50 Square Drive, Suite 210
Victor, NY 14564
- For more information on your rights, read about Medicare Appeals and Grievances or call Medicare at 1-800-MEDICARE (1-800-633-4227).
Resources
California's HMO Guide for Seniors
Information on HMOs for Medicare members
1-866-466-8900 (Spanish, Chinese)
1-866-499-0858 (TTY)
www.opa.ca.gov
CalMedicare
Information on Medicare in California, Medicare Part D and other prescription drug programs, and financial aid for low-income seniors
1-888-430-2423 (Spanish) (publications only)
www.cahealthadvocates.org (Spanish, Chinese, Vietnamese)
HICAP (California Health Insurance Counseling, and Advocacy Program)
Free information, counseling, and advocacy for Medicare members
1-800-434-0222
Health Services Advisory Group (HSAG) - California's Quality Improvement Organization
Help for Medicare members who have a complaint about the quality of care, delays in receiving care, or being sent home from the hospital too soon
1-800-841-1602
1-800-881-5980 (TTY)
www.hsag.com
Medicare
The official Medicare website and phone number.
1-800-MEDICARE (Spanish)
1-877-486-2048 (TTY)
www.medicare.gov (Spanish)
