End stage renal SNP Special Needs Plan is offered by
CareMore /Blue Cross MAPD
in Los Angeles and other areas.

 

Medicare and You 2019 - Everything you want to knowMedicare and You 2019 #10050 - Everything you want to know * See their section on closing the donut hole

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Supplement Plan?

Part D Rx?

Does end stage renal stop one from getting Obamacare if they are under 65?

2019 California Medicare Advantage HMO SNP
Marketing Materials and Forms

Los Angeles ESRD HMO SNP  Summary of Benefits

Anthem MediBlue Dual Advantage (HMO SNP) – H0544 052

The service area includes Fresno, Kings, Madera, and Tulare counties.

Anthem MediBlue Dual Advantage (HMO SNP) – H0544 053

The service area includes the county of Kern.

Anthem MediBlue Dual Advantage (HMO SNP) – H0544 054

The service area includes San Francisco and Sacramento counties.

Anthem MediBlue Dual Advantage (HMO SNP) – H0544 055

The service area includes the county of Ventura.

Anthem MediBlue Dual Plus (HMO SNP) – H0544 087

The service area includes Fresno, Kings, Madera, Tulare counties.

Anthem MediBlue Dual Plus (HMO SNP) – H0544 088

The service area includes Kern county.

Anthem MediBlue Dual Plus (HMO SNP) – H0544 089

The service area includes Sacramento and San Francisco counties.

Anthem MediBlue Dual Plus (HMO SNP) – H0544 090

The service area includes Ventura county.

Anthem Blue Cross Authroized agent
Authorized Blue Cross Anthem Agent - Full Details & enroll online  

Bay Area Assoc of Kidney Patients

  Part C & D Enrollment Periods

SNP is all the time
Part C & D Enrollment Periods

4 comments on “Caremore Medicare Advantage – Special Needs Plan for ESRD Kidney Failure –

  1. I live in Los Angeles and I’m on a transplant waiting list in Washington State. Will a Medicare Advantage Plan pay my expenses out of state?

    • Excellent Question and it’s beyond our pay grade.

      For one, isn’t there a National Kidney registration?

      https://www.kidney.org/atoz/content/transplant-waitlist
      The United Network for Organ Sharing (UNOS) manages the list of all the people across the US waiting for an organ transplant. UNOS ensures that deceased donor organs are distributed fairly using a transparent system

      https://transplantliving.org/kidney/how-could-i-get-a-transplant-sooner/
      There are different kinds of donated kidneys – some with shorter wait times. It will be your job to choose which of these kidneys you’re willing to take – being open to more than 1 kind may make your wait shorter.

      On the other hand:

      http://www.organjet.com/
      OrganJet provides an information service, as well as options for timely and affordable air transport, for patients who are multi-listed or distant listed for organ transplants in the U.S.

      (Did you know that 500+ kidneys are wasted every year while 90000+ people wait on the list? We believe that we can improve the system and are working towards it.)

      In the meantime, you can likely get a transplant earlier by listing smartly.

    • Excerpt from Evidence of Coverage

      What are network providers?

      Network providers are the doctors and other health care professionals, medical groups, durable medical equipment suppliers, hospitals and other health care facilities that have an agreement with us to accept our payment, and any plan cost sharing, as payment in full. We have arranged for these providers to deliver covered services to members in our plan. The most recent list of providers and suppliers is available on our website at https://shop.anthem.com/medicare/ca.

      Why do you need to know which providers are part of our network?

      It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan, you must use network providers to get your medical care and services.

      The only exceptions are emergencies, urgently needed services when the network is not available (generally, when you are out of the area), out-of-area dialysis services and cases in which the plan authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical and other covered services) for more specific information about emergency, out-of-network and out-of-area coverage.

      If you don’t have your copy of the Provider/Pharmacy Directory, you can request a copy from Customer Service (phone numbers are printed on the back cover of this booklet). You may ask Customer Service for more information about our network providers, including their qualifications. You can also see the Provider/Pharmacy Directory at https://shop.anthem.com/medicare/ca or download it from this website. Both Customer Service and the website can give you the most up-to-date information about changes in our network providers.

      Getting an exception is pushing the limits of our pay grade. See also our webpages on medical necessity and appeals.

    • I checked with “my people” at Caremore and they advise that you NOT change plans as it may put in at the bottom of the waiting list!

      Thus, I think your “battle” would be with Medi Cal to pay the 20% that Medicare doesn’t pay.

      Medi-Cal pays out of state when:

      540-1 (a) (5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State.

      https://www.law.cornell.edu/cfr/text/42/431.10

      Medi Cal Treatment Authorization Request

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