CALIFORNIA - Pacificare Health Systems

Medicare Advantage Plan
A policy or benefit package offered by a
Medicare Advantage Organization, under
which a specific set of health benefits
are offered at a uniform premium and
uniform level of cost sharing to all Medicare
beneficiaries residing in the Service Area
covered by the Medicare Advantage Plan.
An MAO may offer more than one Medicare
Advantage Plan in the same Service Area. The
Secure Horizons Group Retiree Medicare
Advantage Plan is a Medicare Advantage Plan.
Medicare Part A
Hospital insurance benefits, including
inpatient Hospital care, Skilled Nursing
Facility Care, Home Health Agency care and
Hospice Care offered through Medicare.
Medicare Part A Premium
Part A is financed by part of the Social
Security payroll withholding tax paid by
workers and their employers and by part
of the Self-Employment Tax paid by selfemployed
persons. Generally, people age 65
and older can obtain Premium-free Medicare
Part A benefits based on their own or their
spouse’s employment. If you are under
65, you can obtain Premium-free Medicare
Part A benefits if you have been a disabled
beneficiary under Social Security or the
Railroad Retirement Board (1-800-808-0772,
for the hearing impaired, 1-312-751-4701) for
more than 24 months. If you do not qualify
for Premium-free Part A benefits, you may
buy the coverage if you are at least 65 years
old and meet certain requirements. Also, you
may be able to buy Medicare Part A if you are
disabled and lost your Premium-free Part A
because you are working.
Medicare Part B
Supplementary medical insurance that is
optional and requires a monthly Premium.
Part B covers Physician services (in both
Hospital and non-Hospital settings) and
services furnished by certain non-physician
practitioners. Other Part B services include
lab testing, Durable Medical Equipment,
Section 1 – Health Care Terms
diagnostic tests, ambulance services,
prescription drugs that cannot be selfadministered,
certain self-administered anticancer
drugs, some other therapy services,
certain other health services, and blood not
covered under Part A.
Medicare Part B Premium
A monthly Premium paid to Medicare (usually
deducted from your Social Security check)
to cover Part B services. You must continue
to pay this Premium to Medicare to receive
Covered Services whether a Medicare
Advantage Plan or Medicare covers you. If you
are eligible for a Medicare Savings Program,
the sate may pay all or part of your Medicare
Part B Premium.
Medicare Part D
A voluntary prescription drug benefit
program approved by Medicare and offered
to Medicare beneficiaries through Medicare
Advantage Organizations, such as PacifiCare,
which offers the Secure Horizons Group
Retiree Medicare Advantage Plan and
Prescription Drug Plans.
Medicare Part D Premium
A monthly premium paid to Medicare Part D
providers, such as PacifiCare to cover Part D
prescription drug coverage. The Medicare Part
D Premium amount is included in the Health
Plan Premium PacifiCare bills to the University
of California.
Medicare Savings Program
A program usually administered by Medicaid
state agencies, which offers assistance to low
income Medicare beneficiaries. This type
of program includes Medicare beneficiaries
who qualify as a Medicaid Qualified Medicare
Beneficiary, Special Low Income Medicare
Beneficiary, Qualified Disabled Working
Individual or a Qualified Individual.
Member
A Medicare beneficiary who has voluntarily
elected to enroll in the Secure Horizons
Group Retiree Medicare Advantage Plan and
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
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PART B