Open Enrollment FAQs for 2020-2021

November 06, 2020

Getting the care you need to grow healthy starts with having the information to make the best decisions about health care for you and your family. 

You can get a better understanding of your choices with this FAQ. We also offer resources for more information and can walk you through your options for free. 

Get help in English: (833) 444-5560
Get help in Spanish: (833) 444-5570

 

Q: What Is Open Enrollment?

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A: Open enrollment is the period each year when everyone has the chance to choose their health care and insurance coverage for the next calendar year. People can decide to stay with their current plan or switch to one that does a better job at meeting their budget or health care needs.

Things to consider:
⦁    The monthly cost or premiums
⦁    Which doctors and hospitals you can visit
⦁    How much you pay for each office visit, prescriptions, and other services
⦁    How much you have to pay out-of-pocket for the year
⦁    If certain care like dental, vision, or counseling is covered

For those on Medicare, open enrollment is also the time when you can choose which doctors and health systems you want to go to. If you’d like to make sure you can see AltaMed doctors, call us so we can help you make the switch.

 

Q: When Is Open Enrollment?

A: That depends on your insurance or medical coverage. The open enrollment period for Medicare runs through December 7. Open enrollment for Covered California is November 1 through January 31.

 

Q: Am I Eligible for Medicare?

A: Medicare is usually reserved for people who are 65 years old or older. You can sign up three months before you turn 65 during the open enrollment period. Younger people with kidney failure requiring dialysis or transplant are also eligible.

There are two parts to Medicare. Part A is hospital insurance and Part B is medical insurance. Part A is free if you’re 65 and you or your spouse paid Medicare taxes for at least 10 years. Part B requires a monthly premium which is deducted from your Social Security check. The premium varies based on income. In 2020 it ranged from $144.60 to $491.60. It covers doctors’ services, outpatient care, home health services, durable medical services, and other medical services.

 

Q: Should I Just Take the Insurance Offered by My Employer?

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A: That seems like a good and simple idea. But it might not be the best for you and your family. Even if employers pay for part of your plan, it may not offer the right kind of coverage and could be expensive.

Research all your options. Depending on your income, you could be eligible for coverage through Medi-Cal or qualify for discounts through the Covered California marketplace. 

 

Q: What Happens If I Don’t Choose?

A: If you’re covered through Medicare, you will likely continue with the same plan you were on. If you are on a plan through your employer or Covered California and your plan goes away, you may automatically get assigned to a plan offering comparable coverage at a similar price. Otherwise, you may be required to re-enroll each year. 

 

Q: What Happens If I Don’t Have Coverage and Miss the Deadline?

A: If your job offers coverage but you miss the deadline, you can’t enroll until the following year unless you have a qualifying life event. You may be able to get a short-term plan, be eligible for Medi-Cal, or the Children’s Health Insurance Program (CHIP). The same is true for Covered California. If you miss your deadline to sign up for Medicare, you can enroll during the General Enrollment Period that runs from January 1 to March 31 every year. Your coverage, however, won’t start until July 1.

 

Q: What Is a Qualifying Life Event?

A: These are events that allow you to change, cancel, or enroll in new coverage outside of the open enrollment period, they include:
⦁    Getting married
⦁    Having a baby
⦁    Losing a job or experiencing a change to your income 
⦁    A death in the family
⦁    Moving to a different ZIP code
⦁    Becoming a U.S. citizen

 

Q: How Can I Save Money on Coverage?

A: Make sure you apply for tax credits or cost-sharing reductions if you purchase a plan through Covered California. That can reduce what you pay.
Some health insurance plans offer discounts if you maintain a healthy weight, enroll in an exercise program, or take part in activities your company requests. There are other ways to save money:
⦁    Choose in-network doctors
⦁    Only visit the emergency room for true emergencies
⦁    Take advantage of covered health screenings: you may qualify to get preventive cancer screenings,  diabetes screenings, HIV and STI tests, and many others at no cost
⦁    If you are given a prescription, ask if a generic version is available

 

Q: Can I Get Help Choosing the Right Insurance?

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A: AltaMed has professionals dedicated to help you understand your health care options. They can provide you with:
⦁    Free one-on-one enrollment assistance over the phone
⦁    Bilingual-certified enrollment counselors
⦁    Information about a variety of health care options including:
⦁    Covered California
⦁    Medi-Cal
⦁    Medicare

Make your appointment today by calling (877) 462-2582 or visit here to get started. 

Learn other ways to get the most from your coverage, regardless of the plan you’re on. And remember, we’re here for you. Call with your questions about selecting coverage that can help your whole family grow healthy – in 2021 and for years to come.
 

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You Need Health Care Coverage Right Now. Let Us Help.

August 13, 2020

For a  variety of reasons many people are now without health care coverage – at a time when there’s a public health crisis raging all around us. Even if you take every precaution to stay safe, now is not the time to be without dependable health care coverage. 

This is a brief rundown of your options. It is not a substitute for advice, and of course, things can change rapidly. That’s why your best bet is to contact us so we can give you personalized advice about your options. Read on to learn more.

 

Getting Insurance Through Medi-Cal

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Medi-Cal is low- or no-cost essential coverage for some of our state’s most vulnerable residents, including those who are:
⦁    Below a certain income level
⦁    Blind
⦁    65 or older
⦁    Disabled
⦁    Under 21
⦁    Pregnant
⦁    In a skilled nursing or intermediate care home
⦁    On refugee status for a limited time, depending on how long you have been in the United States
⦁    A parent or caretaker relative of an age-eligible child
⦁    Have been screened for breast and/or cervical cancer 

If you are eligible for Medi-Cal, you can apply at any time at the Covered California website (also called the exchange). You can choose from plans offered by well-known companies such as Anthem-Blue Cross and Heath Net, and you could also receive public benefits.

Anyone can apply for Medi-Cal, but your immigration status may complicate eligibility or the level of help you can receive.

 

Getting Insurance Through Medicare

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Medicare is for seniors 65 years or older, regardless of their income, medical history, or health status. It also covers younger people with disabilities and people with permanent kidney failure who require dialysis or a transplant. 

Medicare covers many services, including hospitalizations, doctor visits, medications, and even skilled nursing facilities. However, Medicare isn’t just one type of plan:

⦁    Medicare Part A and Part B cover many typical health needs, including doctor visits, preventive services, home health visits, inpatient hospital stays, and more. 
⦁    Medicare Part C, or Medicare Advantage, allows recipients to also enroll in a private health insurance plan to cover gaps in care and keep expenses down.
⦁    Medicare Part D covers outpatient prescription drugs. It is a partnership with private plans.

Most people with Medicare are very satisfied with it. Still, care is not always free, and traditional Medicare does not cover benefits like eyeglasses, dental services, hearing aids, and long-term care. And, as you can see, enrolling in the right combination of plans can be confusing.

 

Getting Insurance Through Covered California

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If you had a job that provided health care coverage but lost it, or had your hours cut and no longer qualify for insurance through work, you could be eligible to get a new plan through Covered California, the state’s insurance exchange. Depending on your income level, you may even qualify for assistance to help you pay for your monthly premiums (but you have to go through Covered California to get it).

If you have experienced one of the following qualifying life events, you have 60 days to apply for a new plan and assistance through Covered California:

⦁    Marriage or divorce
⦁    Loss of Medi-Cal or job-based coverage
⦁    You turn 26 and age out of your parents’ coverage
⦁    Have or adopt a baby
⦁    A death in the family
⦁    Move to a new ZIP code
⦁    Becoming a U.S. citizen

This year, because of the Covid-19 pandemic, California has extended the Special Enrollment period until August 31, to help more people get covered.

If you haven’t had one of the qualifying life events listed above, you can still purchase a plan through Covered California during the regular Open Enrollment period. 

 

Getting Insurance Through COBRA

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If you lose access to your employer-sponsored health insurance, you may be offered COBRA (the Consolidated Omnibus Budget Reconciliation Act, but it is almost always referred to as COBRA). COBRA lets you keep the plan you were on through your employer, but now, instead of your boss covering part of the bill, you are responsible for the entire monthly premium. COBRA lets you continue your plan for up to 18 months.

Usually, getting your plan through COBRA is very expensive, depending on your plan, if your family was covered, and how much your employer paid. However, it may be worthwhile to consider it if you (or someone covered by the plan) require complex medical care and if:

⦁    Your plan was extremely generous
⦁    You have already met your calendar-year deductible or out-of-pocket maximum
⦁    Your health could be jeopardized by a gap in care or not being able to access specific treatments

 

Not Sure About the Best Choice?

Section 5Health care coverage can be confusing, but it doesn’t have to be. Trust the experts at AltaMed to make it simple for you to select and enroll in the plan that’s the best fit for you and your family’s needs. There’s no cost and no obligation. For more information or to connect with us, visit our Health Insurance Resource page today!
 

 

Grow Healthy with Complete Care from AltaMed

January 02, 2020

AltaMed was established in 1969 – in a much different form than what you know today. 

AltaMed President and CEO Cástulo de la Rocha remembered seeing the only health clinic in his neighborhood with lines around the block and knew there had to be a better way for people to get the care they need. And from humble beginnings as the East LA Barrio Free Clinic, AltaMed has continued to grow, adding more coverage and services to serve more people.

Even though we’ve grown from one location to more than 30 health centers throughout Southern California, and have a large network that includes top doctors, some things haven’t changed. We’re still committed to bringing personal, modern care to members of communities that previously haven’t had many options for health services. We staff our facilities with compassionate doctors and staff who speak your language and understand your culture.  And we believe that for communities to grow healthy, we need to advocate for services and resources beyond health care. 

Take a look at some of our core services, then call and make an appointment at (888) 499-9303.

 

Primary Care

doctor and nurse talking in a consultory

Seeing a primary care physician is the first step of your journey to good health. Go to your primary care doctor for routine health screenings and immunizations. And, if you think you may be sick or something is wrong, they can help you get the care you need, even if they have to refer you to a specialist.

We want you to feel comfortable seeing your primary care doctor, which is why we have bilingual doctors and staff. With our doctor finder tool, you can even search for a doctor based on their gender and location. We want nothing to come between you and the care you need.

 

Women’s Health Care

Doctor and nurse talking to a senior woman

Women have unique health care needs. For a variety of reasons, they are also more likely to suffer heart disease, stroke, certain types of cancer, and even some mental health conditions. That’s why they need doctors who understand what it takes to keep them mentally and physically healthy – like the caring doctors who are part of AltaMed Women’s Health Services.

We offer care and services for every stage of a women’s life, including mammograms, family planning, reproductive health, and more. Make an appointment today to learn about age-appropriate screenings – they could save your life!

 

Pediatrics

Pediatrician checking a girl's hear

Your kids depend on you to keep them healthy, and you can depend on AltaMed. Bring your child to see our pediatricians for routine visits. We also offer immunizations that may be available to you and your child for free. 

 

Behavioral Services

Psychologist in a consultation with an elderly man

Life has its ups and downs, and it’s normal to feel sad or anxious once in a while. But if you frequently feel depressed, angry, or like you need to drink or take drugs to cope, it’s time to see a professional. Our compassionate Behavioral Health team can make sure you get the treatment you need. It’s completely confidential, and we can help you get on the road to feeling like yourself again.

 

AltaMed PACE

Elderly eating at PACE canteen

As we age, it’s normal to need a little extra care. For seniors with complex medical needs who aren’t ready for assisted living, AltaMed PACE can help keep them healthy and independent at home. AltaMed PACE is the Program of All-Inclusive Care for the Elderly, and it includes coordinated medical care, social services, transportation, and meals, all in a friendly neighborhood setting that seniors (and caregivers) love. Some seniors may even qualify for more assistance at home. AltaMed PACE may be covered at 100% for Medicare-eligible seniors. Contact us to learn more (877) 499-9303.

 

Dental Services

Woman at dentistry room

We want to help you keep your teeth healthy and bright for life! That means starting early and getting regular checkups, X-rays, and cleanings. 

Bring your entire family to AltaMed for dental services. Kids should start seeing the dentist within six months of developing their first tooth. By visiting the dentist twice a year, as recommended by the American Dental Association, you may be able to keep your teeth for your whole life! Other services include fillings, root canals, crowns, and emergency dentistry.

 

HIV/AIDS Care and Prevention

Guys holding the pride flag

There are more ways than ever to prevent and treat HIV and AIDS. But that doesn’t mean we can give up the fight! We’re dedicated to providing the resources our members need to protect their status and stay healthy, including rapid testing, prevention, and educational services.

For those who are HIV positive, we take a whole-person approach to care. We support our members and their loved ones with a full range of services, such as pharmacy, primary care, behavioral health, and care management.

 

Get Started with AltaMed!

Doctor hugging her little patient

There’s so much we can do to help you grow healthy – and it all starts with an appointment. We accept many different health plans, including Medicare, Medi-cal, and many commercial plans. If you’d like to learn more about your health plan options, we can help with that, too. We look forward to seeing you and helping you live a long, healthy life.