Insurance

Mee Memorial Hospital is committed to working with you and your Health Plan to assure your ability to access our hospital is met. We will bill your insurance for you, although you will be asked to pay deductibles and estimated co-insurance prior to your hospital visit. You must bring your insurance card and all other required insurance information to the hospital with you. If you are uninsured, you will be required to pay for services prior to your hospital visit.

Please reach out and call our Patient Financial Services Department for any special requests at (831) 385-7152 or (831) 385-7294 and we will call your Health Plan on your behalf to verify eligibility and benefits.

Health Insurance Glossary

Co-insurance

Co-insurance is a set percentage of the insured medical expenses that you may have to pay after you reach your deductible. Co-insurance can vary greatly among insurance plans, so check with your insurance provider to find out how much co-insurance you may have to pay.

Co-payment

A co-payment is a set payment made at the time service is received. Co-payments can vary greatly among insurance plans, so please check with your insurance provider to find out how much you have to pay. We ask that you pay your co-payment at the time of registration.

Deductible

A deductible is the amount of money you must pay before the insurance company begins covering part or all of your medical expenses.

EPO (Exclusive Provider Network)

A type of health insurance Plan that, like an HMO, limits health coverage to Doctors and Hospitals within a specific Network. However EPO’s also provide options to allow you as the Patient to see Specialists outside of the EPO Network.

PPO (Preferred Provider Organization)

This type of health insurance Plan covers a wide range of Hospitals, Doctors, Surgery Centers and other Providers all within a Network. However care outside the network might require additional cost.

POS (Point of Service)

This type of health insurance Plan allows you to use Network Doctors, Hospitals and Providers within a specific network defined by the Plan. However, a POS plan requires the patient to seek a referral from your primary care Doctor before seeing a Specialist. At the time of any referral it is possible you may be responsible for additional co share costs.

HMO (Health Maintenance Organization)

A type of health insurance Plan that limits health coverage to very specific Doctors, Specialists, Hospitals and other Providers within a limited Network contracted under this HMO Plan.

Affordable Care Act

On March 23, 2010, President Obama signed the Affordable Care Act into law, putting into place an extensive reform in order to improve access to affordable healthcare coverage for Americans. For those who are uninsured, or for those who do not get their healthcare coverage through work, a key component of the new law took effect October 1, 2013, providing consumers a new Health Insurance Marketplace. This Marketplace will allow millions of Americans to comparison shop for a variety of coverage that will best meet their healthcare needs. For more information on the new healthcare act, visit https://www.healthcare.gov.

Covered California

The website for California’s Marketplace is https://www.coveredca.com

Here Californian’s can shop and compare quality, affordable health insurance that took effect January, 2014. Through Covered California, you can also find out if you qualify for Medi-Cal, as well as help you determine if you qualify for any type of assistance programs.

Medicare Basics

Do you have to pay for Medicare?

Part A – Hospital

A monthly payment, or premium, is not required for most people (including spouses) who paid Medicare taxes while they were working – generally at least 10 years. You don’t pay a premium if you are 65 or older and you get retirement benefits from Social Security or the Railroad Retirement Board. You also don’t pay a premium if:

You are younger than 65 and have received Social Security or Railroad Retirement Board disability benefits for 24 months.
You have end-stage renal disease (kidney failure) and need dialysis or a transplant..

If you are 65 or older and don’t qualify for premium-free Medicare Part A, you can buy Part A with a monthly premium. If you buy Part A, you also need to pay a premium for Part B. Check online at www.medicare.gov for details on premium amounts.

You usually need to pay some amount (deductibles or co-pays) for services before Medicare pays. But if you have a Medigap policy, it may cover your deductibles and co-pays. (See “What is Medigap?” for more information.)

Part B – Medical

Most people pay a standard monthly premium and an annual deductible. Above a certain income, you pay more based on the amount of your income. Most preventive services — such as flu shots, mammograms and colorectal screenings — are free if the provider accepts Medicare.

Part C – Medicare Advantage

These plans have different out-of-pocket costs depending on the plan you choose.

All-in-one Medicare Advantage plans help simplify the complexity around Medicare by combining your Medicare Part A and Part B and may offer additional benefits not covered by Original Medicare — including Medicare Part D†.

† Available with Medicare Advantage Prescription Drug Plans – Medicare-approved plans offered by private insurance companies

Part D – Prescription

You pay a premium for the Medicare prescription drug plan, which can vary based on what is covered in the plan.

Exclusions

Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself unless:

You have other insurance that covers these services
You have a Medicare Advantage plan that covers them

Even if Original Medicare covers a service or item, you generally have to pay your deductible and coinsurance.

Some of the items and services that Original Medicare doesn’t cover include:

Long-term care
Most dental care
Eye exams related to prescribing glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care