HMO Guide for Seniors - Office of the Patient Advocate - State of ...

More documents

Recommendations

Info

What HMO members have to say about the original California’s HMO Guide: The University of California, Berkeley Office of the Patient Advocate “This gives you a license to say, I am in charge of my health and when I ask questions I need answers.” “I was amazed at how much information is in here that you can utilize right now.” “I don’t feel lost anymore. In the past I have felt intimidated, but now have learned to ask questions.” California’s HMO Guide for Seniors is a tool to help you use your Medicare HMO. This guide has answers to many common questions. It does not offer legal advice, but it will tell you about your rights. It will tell you some places you can go to find more help and to learn more about your rights. When you use this guide, remember that each Medicare HMO is different. Call your HMO to learn more about its rules and the care it offers. California’s HMO Guide for Seniors is produced by the University of California, Berkeley, in collaboration with the California Office of the Patient Advocate and communities throughout California. To order a free copy of California’s HMO Guide for Seniors in English or Spanish or for information on alternative formats, call: 1-888-466-2219 TTY 1-877-688-9891 © 2010 by The Regents of the University of California. All rights reserved. Second edition. No part of this publication can be reproduced, published, adapted, distributed, or transmitted in any form by any means (including electronic, microcopying, photocopying, or otherwise) without prior written permission of the copyright owner. Legal Disclaimer This guide contains general information only and is not a substitute for the advice of health care professionals, consumer advocates, legal advisors, or qualified health plan representatives. Neither The Regents of the University of California nor the Office of the Patient Advocate represent or warrant that the contents of this guide are complete or without error. Frequent changes in managed health care or in legal protections for consumers may cause the guide to become outdated, obsolete, inaccurate and/or incorrect. In no event will The Regents of The University of California, the Office of the Patient Advocate, or any individual or entity involved in the production of this publication be liable to any party for any direct, special or other consequential damages resulting, directly or indirectly, from any use of this guide or of any website or phone number contained in this guide. Please consult with a qualified representative from your health plan for specific information about your health plan. Cover photo credits: © Fotosearch/Digital Vision; © Creatas; © GettyImages/ Photodisc; © Mark Tantrum. Back cover: © Doug Menuez/GettyImages; © Keith Brofsky/GettyImages; © GettyImages/Digital Vision
What’s Choosing the Guide An HMO your HMO Page Welcome .......................................................................................... 2 Know Your Health Care Choices If You Are New to Medicare ......................................................... 4 What Is a Medicare HMO? .......................................................... 6 Choosing a Medicare HMO ......................................................... 8 Joining or Leaving a Medicare HMO .......................................... 10 Paying for a Medicare HMO ........................................................ 12 Paying for Prescription Drugs ....................................................... 14 Help Paying for Medicare ............................................................. 16 When You Retire ............................................................................. 18 You and Your Doctor Take Charge of Your Health Care ................................................ 20 Choosing a Doctor .......................................................................... 22 Talking with Your Doctor .............................................................. 24 Choosing Treatments ..................................................................... 26 Making Your Wishes Known ....................................................... 28 If You Have a Disability ................................................................ 30 If You Need Help in Your Language ............................................ 32 Know Your Benefits Your Medicare HMO Benefits ..................................................... 34 Preventive Care .............................................................................. 36 Specialist Care ................................................................................ 38 Prescription Drugs ......................................................................... 40 Medical Supplies and Equipment ................................................. 42 Care for Chronic Conditions ........................................................ 44 Mental Health Care ........................................................................ 46 Emergency Care ............................................................................ 48 Hospital Care ................................................................................. 50 Home Care .................................................................................... 52 Nursing Home Care ...................................................................... 54 Care at the End of Life ................................................................. 56 If You Have a Problem If You Can’t Get the Care You Need ............................................ 58 Customer Service/Quality of Care Problems ................................ 60 Useful Terms .................................................................................... 62 Phone Numbers and Websites ...................................................... 64 Index .............................................................................................. 67 © Corbis © PhotoLibrary © Dave & Les Jacobs/GettyImages © LWA/Dann Tardif/GettyImages © Tom Grill/Corbis
Page 1: California’s HMO Guidefor Seniors
Page 5 and 6: Office of the Patient Advocate www.
Page 7 and 8: 5 Questions & Answers How do I pay
Page 9 and 10: 7 Questions & Answers How do I know
Page 11 and 12: 9 Questions & Answers How can I lea
Page 13 and 14: 11 Questions & Answers My HMO is le
Page 15 and 16: 13 Questions & Answers What do I pa
Page 17 and 18: 15 Questions & Answers I do not hav
Page 19 and 20: 17 Questions & Answers Are there an
Page 21 and 22: 19 Questions & Answers Do I need Me
Page 23 and 24: 21 Questions & Answers Does it real
Page 25 and 26: 23 Questions & Answers Can I keep m
Page 27 and 28: 25 Questions & Answers My doctor is
Page 29 and 30: 27 Questions & Answers How can I ge
Page 31 and 32: 29 Questions & Answers I filled out
Page 33 and 34: 31 Questions & Answers I have a dis
Page 35 and 36: 33 Questions & Answers How can I ma
Page 37 and 38: 35 Questions & Answers How can I fi
Page 39: 37 Questions & Answers Will my plan
Page 42 and 43: 40 Prescription Drugs Phil carefull
Page 44 and 45: 42 Medical Supplies and Equipment M
Page 46 and 47: 44 Care for Chronic Conditions M an
Page 48 and 49: 46 Mental Health Care M any people
Page 50 and 51: 48 Emergency Care I n an emergency,
Page 52 and 53:
50 Hospital Care F or some care, yo
Page 54 and 55:
52 Home Care Y ou may need extra he
Page 56 and 57:
54 Nursing Home Care M edicare HMOs
Page 58 and 59:
56 Care at the End of Life W ork cl
Page 60 and 61:
58 If You Can’t Get the Care You
Page 62 and 63:
60 Customer Service/Quality of Care
Page 64 and 65:
62 Useful Terms Advance Health Care
Page 66 and 67:
64 Phone Numbers and Websites Most
Page 68 and 69:
66 Phone Numbers and Websites Resou
Page 70 and 71:
68 Index m-p Medi-Cal 10, 16-17, 42
Page 72:
California’s HMO Guide for Senior
show all

HMO Guide for Seniors - Office of the Patient Advocate - State of ...

Create successful ePaper yourself

Delete template?

Save as template?