Medicare

Medicare

Seniors on Medicare parts A&B are able to use their insurance at Pinnacle Medical Group. The group also accepts many Medicare plans including Medicare Advantage plans, Medicare PPOs/supplemental plans.

Medicare Advantage Plans

Medicare Advantage plans are a  type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Advantage Plans accepted at Pinnacle Medical Group:

  • AARP Medicare Complete by Secure Horizons/ United
  • Aetna
  • Anthem Blue Cross
  • Blue Shield 65+
  • Central Health Plan
  • Citizens Choice
  • Health Net
  • IEHP Dual Choice (Medicare and Medi-Cal)
  • Inter Valley Health Plan
  • Medicare
  • SCAN

Original Medicare

Seniors on parts A&B only are able to call to schedule an appointment at any time. Without additional supplemental coverage (an Advantage plan or PPO plan) they will pay 20% of the cost of the doctor’s visit.

Medicare Supplemental Plans (Medi-Gap or PPO plans)

Some people choose a Medicare supplemental plan that picks up the costs (20%) not covered by original Medicare. There is a monthly cost for these plans, plus participants need to buy a separate Part D plan to cover prescription costs. Usually people that can afford an extra $150-$200 per month for coverage that want to be able to walk-in to any Medicare office without a referral choose these types of plans.

Medicare Plan Comparison Service

Benefits vary in the different plans. We are recommending an independent service that can assist you with choosing the plan that will best meet your needs. Insurance representatives from a licensed agency we know and trust can review all of the Medicare plans in one visit with you to:

  • Compare the benefits & costs of multiple Medicare plans
  • Help you find the plan that saves you the most money
  • Review drug coverage & find out if your prescriptions are covered

Our Medicare patients have told us this service has been extremely helpful so we are now offering it to you. Please call our Fontana office att (909) 427-1303 for more information about this service.

For complete information about Medicare, please visit: www.medicare.gov

Medicare/Medi-Cal

Low Income seniors may qualify for special plans. Pinnacle accepts Medi-Cal patients with Medicare (also know as Dual Eligible or Medi-Medi).

To apply for Medi-Cal, go to www.c4yourself.com. This website will also determine if you qualify for California State Cash Assistance, Food and Nutrition Beneifts and Medi-Cal. You can also apply for Medi-Cal with an eligibility worker stationed at county clinics or your local Department of Public Social Services. Individuals making up to $15,415 a year or families making up to $31,810 a year may qualify for Medi-Cal insurance at no cost to them.

You can qualify for Medi-Cal if you get cash assistance under:

  • SSI/SSP
  • CalWorks
  • Refugee Assistance
  • Foster Care of Adoption Assistance Program

If you do not get cash assistance, you may still qualify for Medi-Cal. You must meet one of the following:

  • Low-income parents, caretaker relative, or child under 21 if:
    • The child’s parent is deceased or doesn’t live with the child, or
    • The child’s parent is incapacitated, or
    • The child’s parent is under employed or unemployed
  • Low-income seniors (65 years or older)
  • People who are legally blind or disabled
  • Low-income pregnant women
  • Diagnosed with breast or cervical cancer
  • People under 21 years
  • Persons in a skilled nursing or intermediate care home