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What is Medcore Gold? Who is eligible for Medcore Gold? How do I enroll in Medcore Gold? What makes Medcore Gold different than original Medicare? What is the service area for Medcore Gold? Do I need a Primary Care Physician? Can I make a change in my Primary Care Physician? Do I need a referral to a specialist? What is Low or Limited Income Subsidy (LIS)? Who Qualifies for Low Income Subsidy? What happens when Medicare doesn't show I'm eligible for LIS, but I have proof that I am eligible? What is Medcore Gold?Medcore Gold is a licensed California HMO with a Medicare Advantage Part D Prescription Drug Program contract.Top Who is eligible for Medcore Gold?Anyone with Medicare Parts A and B, including those under 65 entitled to Medicare on the basis of Social Security disability. To join Medcore Gold you must continue to pay your Part B Medicare premium, live in San Joaquin County, use Medcore HP providers, and not have End Stage Renal Disease (ESRD).Top How do I enroll in Medcore Gold?Just call us!We can provide you with an Information & Enrollment Package that includes all of Medcore Gold's information as well as an Enrollment form. If you would like to attend one of our informational seminars, please call 800-320-5688 (TTY 1-800-258-6810 for the hearing impaired) Monday through Friday, 8:00 a.m.- 5:00 p.m. To request information online fill out our Information & Enrollment Package or email us at Member Services. Top What makes Medcore Gold different than original Medicare?Medcore Gold provides benefits beyond original Medicare, including $50 towards eyewear every two years, acupuncture, routine physical exams, prescription drugs, health education and preventive services, and worldwide emergency and urgently needed services.Top What is the service area for Medcore Gold?Medcore Gold's service area is San Joaquin County.Top Do I need a Primary Care Physician?Yes, you will need to select a Primary Care Physician from among Medcore HP's 120 Primary Care Physicians. We believe the Primary Care Physician is critical to the coordination of your care and services, and is central to ensuring that your health care needs are met.Top Can I make a change in my Primary Care Physician?Yes, you may make a change in your Primary Care Physician at anytime. The change will be effective on the first of the month following your request. A new membership card will be sent to you noting your new Primary Care Physician. Should you wish to make a change, just call Member Services at 800- 320-5688 (TTY (800)-258-6810 for the hearing impaired, Monday through Friday, 8:00 a.m.- 5:00 p.m. and we will check to make sure the doctor you are requesting is accepting new patients, and if so we will tell you over the phone when the change will be effective.Top Do I need a referral to a specialist?You do not need a referral authorization from Medcore HP as long as you are seeing a specialist within Medcore HP's local network. However, you will need a referral from your Primary Care Physician. Referrals for routine women's health exams, including Mammography, Pelvic Exams and PAP Smears do not require a referral. However, you must see a provider within Medcore HP's local area network.Top What is Low or Limited Income Subsidy (LIS)?Medicare beneficiaries who have limited income and resources may qualify for extra help to pay for prescription drugs costs. This low-income subsidy from Medicare provides financial assistance for beneficiaries who have limited income and resources. Those who are eligible for this low-income subsidy will get help paying for their monthly premium, yearly deductible, prescription coinsurance and copayments and no gap in coverage.Top Who Qualifies for Low Income Subsidy?Some people are automatically eligible for the low-income subsidy. Those include people who are: full benefit dual eligibles (beneficiaries with Medicare and Medi-Cal with no share of cost); SSI recipients with Medicare; Medicare Savings Programs participants.Some people must apply through SSA. This includes Medicare beneficiaries with income below 150% Federal Poverty Level (FPL) who meets an asset test - i.e. - beneficiaries who have a yearly income (in 2008) below $15,600 ($21,000 for a married person living with a spouse and no other dependents) and resources (in 2008) less than $11,990 ($23,970 for a married person living with a spouse and no other dependents). Generally, dual eligibles and others deemed eligible for low-income subsidy pay no Part D plan premiums or deductibles, but pay $1.10 or $3.20 for generic drugs and $2.40 or $6.00 for brand-name drugs, depending on their income. Top What happens when Medicare doesn't show I'm eligible for LIS, but I have proof that I am eligible?Medicare relies on monthly files from the states and Social Security to establish an individual's low-income subsidy deemed eligibility and appropriate cost-sharing level. In certain cases, CMS systems do not reflect a beneficiary's correct LIS deemed status.When that occurs, the plan can initiate LIS status corrections. The Plan must follow best available evidence guidance and collect documentation to substantiate the beneficiary's LIS status. CMS Best Available Evidence Policy Top |
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Gold Home 2009 Benefits 2009 Evidence of Coverage 2008 Benefits 2008 Evidence of Coverage Provider Directory Prescription Drugs Enrollment |