LA Care Health Plan – Medi-Cal, Medicare Plus, PASC-SEIU Health Plans

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LA Care HMO plans offer some of the lowest pricing in Los Angeles and compete well against national carriers like Anthem and Blue Shield.

LA Care provides community resource centers in East L.A., Lynwood, Inglewood, and Boyle Heights, offering member support services and enrollment in local assistance programs.

Medi-Cal

Medi-Cal is California’s health care program to assist low-income families, seniors, and people with disabilities. Funded with state and federal dollars, Medi-Cal provides health coverage for various medical services and health-related benefits based on eligibility criteria relating to income, health status, and region/program type; some require you to meet income or asset limits, while other programs have higher limits than that.

California residents overwhelmingly rely on Medi-Cal for their health care needs, with coverage including doctor visits, prescription drugs, and hospital stays. Over 13 million Californians depend on Medi-Cal as their primary source of coverage – about one-third of the state population! In addition, Medi-Cal offers wrap-around range to most senior Medicare recipients.

Medi-Cal is funded primarily with federal dollars; however, the California Department of Health Care Services administers it and serves as its principal administrator. Their main goals are providing access to quality health care and ensuring recipients get all the services needed.

DHCS works closely with local agencies and communities to design healthcare systems that focus on community outcomes and value, quality measures, and accountability – for instance, through their Managed Care Performance Dashboard, which collects and reports on plan performance data, Consumer Assessments of Healthcare Providers and Systems surveys, Health Effectiveness and Data Information Set (HEDIS) scores, as well as descriptions on member complaints, grievances, and resolutions, are also published by this agency.

In some counties, DHCS contracts private health plans to deliver managed care services to Medi-Cal beneficiaries. These contracts, known as Section 1915(b) waivers, give programs flexibility in how they provide services to the public while making payments that would have otherwise been invoiced under fee-for-service rates possible; they can even use private funding for extra benefits not covered by traditional Medicare/Medi-Cal programs.

Covered

Covered is a health plan with different levels of benefits for every budget, offering physicians, hospitals, and other service providers who have agreed to provide covered services at specific rates. Some plans require you to select a primary care provider (PCP) or require referrals for specialists. Your project must also provide a Summary of Benefits and Coverage document outlining its coverage, costs, and limitations. Carefully read over this information before receiving any services; items not typically covered include those offered through out-of-network providers or not medically necessary services. If you have any inquiries, please reach out – financial help may be available for monthly premium payments!

Plan Deductible: Before your plan begins covering certain products and services, this amount must first be paid out-of-pocket by you.

Medicare Plus

Medicare Plus is a group plan to supplement Medicare Parts A and B by covering deductibles, coinsurance, and excess charges for both A and B coverage. Members can select their doctors without being limited by provider networks, reimbursement worldwide for services covered by Medicare, and protections against fees that exceed usual, customary, and reasonable amounts when using an out-of-network provider; however, this plan does not meet federal requirements regarding provider networks, so a referral from your primary care physician must be obtained for specialty care services.

PASC-SEIU Homecare Workers Health Care Plan

PASC-SEIU Homecare Workers Health Care Plan was designed with IHSS providers in mind; those that enable people to remain safely at home by providing personal care or assistance are eligible for coverage under this plan. Benefits offered under it include health, dental, and vision coverage and long-term care costs such as medication, health-related equipment, and supplies – not forgetting education and training opportunities targeted explicitly for IHSS providers! It was co-created with United Long Term Care Workers Union SEIU Local 2015 staff and LA County IHSS staff for maximum efficiency!

The Medicare Advantage plan offers its members numerous advantages, including access to a network of doctors and hospitals and nurse advice line services. Furthermore, 24-7 member call center customer service in both English and Spanish provides customer care support; there is also a directory listing pharmacies, physicians, and other health care professionals included with this plan as part of traditional Medicare.

To qualify for the PASC-SEIU Homecare Workers Health care plan, an IHSS provider must work at least 74 hours in two consecutive months as an IHSS provider in Los Angeles County while being enrolled in Medi-Cal; furthermore, they must be employed with LA County Department of Public Social Services and not have been terminated from employment by them.

Anyone wishing to apply for the PASC-SEIU Homecare Workers Health Care Plan must do so through DPSS. Trained staff from designated community agencies, Family Resource Centers, and LAUSD offices can help individuals complete the necessary forms and submit them by the fifth of each month so their coverage starts the following month. Applications must be received no later than 5 PM each month to be effective on 1/1/12.

John Baackes is CEO of LA Care Health Plan, the nation’s most extensive publicly operated health plan. As such, his primary focus is transforming health care through innovations that enhance quality and affordability. With extensive healthcare experience, having previously held leadership roles at Philadelphia-based AmeriHealth Caritas VIP Plans, CEO of Senior Whole Health in Cambridge, MA, president of Kaiser Permanente’s Northeast Division as well as sitting on their Board he is well suited to oversee the implementation of innovative safety net programs to save money and enhance outcomes for vulnerable populations.