JOHN SAMPLEMM/DD/YYYY

ANY ADDRESS

ANY TOWN CA XXXXX

Important notice about your Medicare and Medi-Cal benefits

Important Information about your Medicare and Medi-Cal benefits

Dear [name]:

You are getting this letter because you have both BOTH Medicare and Medi-Cal. The way you get yYour health care is changing. You will now have more choices to meet your health care needs.You must make a choice about enrolling in a health plan or the State of California will choose for you. Read this letter to understand this change and your choices.

This is your second letter telling you about your new options. You may choose a Cal MediConnect plan, or choose to stay with regular Medicare. If you choose to stay with regular Medicare, you must choose a Medi-Cal health plan for our Medi-Cal benefits. If you do not make a choice, we will choose one of the Cal MediConnect plans for you.

Based upon your past services and health care needs, you have been assigned to the Cal MediConnect plan named below. Unless you choose to stay with regular Medicare, you do not need to do anything and your coverage in this plan will become effective on MM/DD/YYYY: [Health Plan Name]

What How will this is the change affect me?

Enrolling in a Cal MediConnect plan will:

  • AllKeep your Medicare or Medi-Cal benefits without any extra costs. benefits, including doctors, hospitals, and prescription drugs.
  • Medi-Cal benefits, including medical equipment, medical supplies and long-term care services and supports like personal care through the In-Home Supportive Services (IHSS) Program and adult day health care through Community Based Adult Services (CBAS) centers.Keep all of the services or benefits you receive now.
  • Dental care and vision care.Ensure that all of your doctors, specialists, and other providers will work together to get you the care you need.
  • New benefits and services that you may not be getting now, such asGive additional transportation, a 24-hour nurse advice line, and no copayments. and vision benefits.

The State of California is going to enroll you into a Cal MediConnect health plan. A health plan is a group of health care providers that work together to give you the care you need.

Cal MediConnect plans are special health plans that cover nearly all Medicare and Medi-Cal benefits plus dental and vision care. This means you can call one place for help with all of your health care needs.

Unless you make a different choice, you will be enrolled in the Cal MediConnect plan below on MM/DD/YYYY:

Health Plan Name

NOTE: If you don’t want to join this plan, read about your choices on page 2.

Why is this change happeningHow does a Cal MediConnect plan help me?

The change is happening so your Medicare and Medi-Cal benefits work together and work better for you.

Your other choices include:

  1. You can enroll in a differentEnrolling in a Cal MediConnecthealth plan. Cal MediConnect plans cover both Medicare and Medi-Cal services. If you join a Cal MediConnect plan, you will receive In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), Community-Based Adult Services (CBAS), and nursing home care through the Cal MediConnect plan. They also cover vision care and transportation. The Cal MediConnect plan will work with your doctors and providers to ensure you get the care you need.
  1. Enrolling in the Program for All-Inclusive Care for the Elderly (PACE). If you are 55 or older and need a higher level of care to live at home, you may be able to join PACE. PACE provides all Medicare and Medi-Cal benefits plus some extra services to help seniors who have chronic conditions live at home.
  1. Enrolling in a Medi-Cal health plan. If you choose to stay with regular Medicare, you will not be assigned to a Cal MediConnect plan, but you must still choose a health plan in order to receive Medi-Cal. Joining a Medi-Cal plan will allow you to keep your Medicare doctors and hospitals and you will not lose any services. You will receive In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), Community-Based Adult Services (CBAS), and nursing facility care through the plan.

Read about the other plans in the “My Medi-Cal Choices” booklet that came with this letter.

OR

You can keep your Medicare the way it is now. But, you need to enroll into a Medi-Cal Health Plan..

You must enroll in a Medi-Cal plan to get your Medi-Cal benefits. The Medi-Cal plan will not affect your Medicare doctors and hospitals. Your extra Medicare costs, like deductibles, will be paid by the Medi-Cal plan instead of the State.

→ If you don’t choose a Medi-Cal health plan for your Medi-Cal benefits, the state will choose for you.

OR

You may be able to enroll in the Program for All-Inclusive Care for the Elderly (PACE) if you are 55 or older and need a higher level of care to live at home. PACE provides all Medicare and Medi-Cal benefits plus some extra services to help seniors who have chronic conditions live at home. Look in your Health Plan Guide and Choices Book to learn more about PACE.

What should I do now?

STEP 1: Review the three choices above and decide which is best for you. Use the Health Plan Guidebook and Choice Book that camewill come in the mail from Health Care Options with this letter to help you. Ask your doctors and other health care providers to see which plans they work with.

You do not need to do anything to join the Cal MediConnect plan below.

If you do not want to enroll in [Health Plan Name], you can contact Health Care Options to select a different Cal MediConnect plan or to stay in regular Medicare. Contact Health Care Options by MM/DD/YYYY.

Call STEP 2: Notify Health Care Options about your choice.

→ You don’t need to do anything to join Health Plan Name starting MM/DD/YYYY.

→ If you don’t want to enroll in Health Plan Name, you must tell us by MM/DD/YYYY.

Tell the state your choice by calling the Medi-Cal’s Health Care Options at the number below OR by filling out and mailing back the Health Plan Choice Form with the enclosed envelope. This form is in your Choice Book that came with this letterwill come in the mail from Health Care Options.

On the Health Plan Choice Form:

To choose a different Cal MediConnect plan complete #1.

To keep your Medicare like it is today but choose a plan for your Medi-Cal benefits only, complete #2.

To choose a PACE plan complete #3.

Mail the form back using the envelope included.

REMINDER: If you do nothing, you will be enrolled in Health Plan Name starting MM/DD/YYYY.

For help or more informationThere is no extra cost to join a Cal MediConnect plan. You keep all of your current benefits after joining.

Why should I join a Cal MediConnect Health Plan?

In a Cal MediConnect health plan, your doctors, pharmacists, long term care services and supports, and other providers work together to care for you. This is called “care coordination.”

Cal MediConnect health plans include all the services below:

All Medicare benefits, including doctors, hospitals, and prescription drugs.

Medi-Cal benefits, including medical equipment, medical supplies and long-term care services and supports like personal care through the In-Home Supportive Services (IHSS) Program and adult day health care through Community Based Adult Services (CBAS) centers.

Dental care and vision care.

New benefits and services that you may not be getting now, such as transportation, a 24-hour nurse advice line, and no copayments.

Can I still go to the doctors and hospitals I use now?

You must go to doctors and providers who work with your health plan, or are “in the health plan’s network.” Ask your doctors if they work with [INSERT PLAN NAME]. If they don’t, you may still be able to see them for six months.

What if I do not want to join Cal MediConnect?

You have other choices. You do not have to join Health Plan Name.

IMPORTANT: You must call Health Care Options at 1-800-430-4263 by MM/DD/YYYY to tell them your choice.

Your other choices:

You can enroll in a different Cal MediConnect health plan. Read about the other plans in the “My Medi-Cal Choices” booklet that came with this letter.

OR

You can keep your Medicare the way it is now. But, you need to enroll into a Medi-Cal Health Plan..

You must enroll in a Medi-Cal plan to get your Medi-Cal benefits. The Medi-Cal plan will not affect your Medicare doctors and hospitals. Your extra Medicare costs, like deductibles, will be paid by the Medi-Cal plan instead of the State.

→ If you don’t choose a Medi-Cal health plan for your Medi-Cal benefits, the state will choose for you.

OR

You may be able to enroll in the Program for All-Inclusive Care for the Elderly (PACE) if you are 55 or older and need a higher level of care to live at home. PACE provides all Medicare and Medi-Cal benefits plus some extra services to help seniors who have chronic conditions live at home. Look in your Health Plan Guide and Choices Book to learn more about PACE.

What should I do now?

STEP 1: Review the three choices above and decide which is best for you. Use the Health Plan Guide and Choice Book that came with this letter to help you. Ask your doctors and other health care providers to see which plans they work with.

STEP 2: Notify Health Care Options about your choice.

→ You don’t need to do anything to join Health Plan Name starting MM/DD/YYYY.

→ If you don’t want to enroll in Health Plan Name, you must tell us by MM/DD/YYYY.

Tell the state your choice by calling the Medi-Cal’s Health Care Options at the number below OR by filling out and mailing back the Health Plan Choice Form. This form is in your Choice Book that came with this letter.

On the Health Plan Choice Form:

To choose a different Cal MediConnect plan complete #1.

To keep your Medicare like it is today but choose a plan for your Medi-Cal benefits only, complete #2.

To choose a PACE plan complete #3.

Mail the form back using the envelope included.

REMINDER: If you do nothing, you will be enrolled in Health Plan Name starting MM/DD/YYYY.

For help or more information

If you want to talk to a health insurance counselor about these changes and your choices, call the California Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222.

If you have questions about Medicare, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

If you want to select a different Cal MediConnect plan, stay in regular Medicare, or get this letter If you need this letter in another language or alternate format - , like large print, audio, or Braille, please call Health Care Options Monday-Friday 8am-5pm at 1-844-580-7272 or TTY: 1-800-430-7077.

If you need further help, call the Cal MediConnect Ombudsman at 1-855-501-3077. This number will be operational starting 4/1/2014.;or if you need help understanding this letter, please call:

Health Care Options

1-800-430-4263844-580-7272

TTY: 1-800-430-7077

Monday - Friday, 8 am - 5 pm

Or visit

Common Frequently Asked Questions and Answers

1.What is the different difference between Medicare and Medi-Cal?

Medicare and Medi-Cal are two separate programs that cover different services for eligible individuals. By joining a Cal MediConnect plan, your Medicare and Medi-Cal benefits will work together and work better for you. for people who are in both programs.

Medicare covers medical services like doctors, specialists, hospitals, and prescription drugs. Medicare also covers some medical equipment and home health.

  • Medi-Cal covers any costs that Medicare doesn’t pay for, including:
  • Dlike deductibles,
  • IHSS, CBAS, MSSP, and nursing home care,
  • . Medi-Cal covers long-term services and supports that Medicare doesn’t pay for, such as Ttransportation to medical appointments,
  • 24-hour nurse advice line for help . Medi-Cal also covers Mmedical equipment and supplies, that Medicare doesn’t pay for like bandages or diapers.

2.What are the benefits of enrolling in a Cal MediConnect plan?

  • You will get all of your Medicare and Medi-Cal benefits in one health plan, including doctors, hospitals, and prescription drugs.
  • You will have get one plan membership card and one phone number to call for when you need help with all your health care needs.
  • You will get dental and vision care , and some transportation to medical appointments.
  • You can call a 24-hour nurse advice line for help.
  • You can get a care coordinator. This person will answer your questions, help you find community services, assist you in making your medical appointments, and help you talk with your doctors.
  • Your Cal MediConnect plan will ask about your health care needs and work with you to create a personal care plan based on your goals.

You can get a care coordinator. This person will answer your questions, help you find community services, make medical appointments, and help you talk with your doctors.

You will get dental and vision care, and some transportation to medical appointments.

Your health plan will ask you about your health care needs and work with you to create a personal care plan based on your goals.

3.How can I be sure my care continues after I join a Cal MediConnecthealth plan?

Your new health Cal MediConnect plan is required to make sureensure that you receive the quality care you need your care is not disrupted. Your health Cal MediConnect plan will contact you within three months after you enroll to learn about your health care needs. They will work with you to make sureand create a plan to make sure you get all needed the care you need.

If you have a scheduled treatment and are changing health plans, call your new health Cal MediConnect plan right away. Tell the health plan about your upcoming treatment so they can work with you.

  • If you see a doctors who are not part of the health plan’s network, you may be able to see thecan keep seeing this doctor for a up to six months if the doctor agrees to your new health plan’s rates, and has no quality issues. Your doctor must agree to work with your health plan.
  • If you are in a Medi-Cal nursing home,the plan Cal MediConnect plan will work with you and your care team so you get the care you need. You have a right not to change nursing homes for the first 12 months after changing from original Medi-Cal to a Medi-Cal health planYou can stay in your nursing home.
  1. What can I do if I join a Cal MediConnect or PACE plan and don’t like it?

In any month, you can dis-enroll from Cal MediConnect or PACE and go back to the regular Medicare or Medicare Advantage plan. To do this, call Health Care Options at 1-844-580-7272 (TTY: 1-800-430-7077), or tell your health plan that you want to leave the plan. The health plan can help you make this choice.

  • Remember that you will still be enrolled in the health plan for your Medi-Cal benefits. Your dis-enrollment only affects how you get your Medicare benefits.
  1. What are Llong Tterm care Sservices and Ssupports? How will they work in a health plan?

Long Tterm care Sservices and Ssupports (LTSS) are Medi-Cal benefits that help you with on-going personal care needs. In a health plan, these services and supports will work like they do today.

Your health plan will work with your doctors and long term services and supportsLTSS providers. If you do not get these services now, your health plan can help you get them in the future if they are medically needed.

  • In-Home Supportive Services (IHSS): Personal care services for people who need help to live safely in their homes.

If you get IHSS, your services will not change. you do not have to change your IHSS providers and yYou can keep your IHSS providers and you can still hire, fire, and manage your providers. The county IHSS social worker will still assess your needs and approve your IHSS hours. Your rights to appeal will stay the same. If you want, your health plan can work with you and your IHSS providers to make sure you get the care you need.