在希摩老人中心举行的一场BCBS蓝盾公司老人特供医保计划推介会上，很多华人老人听了以后说：“这听起来好得像骗人的。”为此，会后我们特意咨询了橙郡老龄部专门负责联邦Medicare老人医疗保险的工作人员Jeanne Chamberlin，确认了关于这系列保险的相关问题。
1.你推荐老人加入BCBS蓝盾公司的特供医疗保险计划吗？
推荐。我鼓励符合条件的老人都选择一个特供医保计划。但是不要只考虑BCBS蓝盾公司而已。其实，市面上有20多家公司都提供这种非常优惠的保险。
2.这种特供医疗保险到底是什么东西？怎么会有那么多优惠条件？
这种老人特供医疗保险（Special Needs Plans for Dual Eligible）是专门为同时具有Medicaid（低收入医保，俗称白卡）和Medicare（退休养老医保，俗称蓝红卡）的老人准备的特供医保。只有同时拥有两种卡的老人才能够享受。
这种特供医保除了每个月不需要支付任何费用，各种医疗项目基本全部报销外，还每年为牙科、眼科、听力设备的各提供几千美金报销额度。最令人惊喜的是，他们还提供免费的健身房会员，还有每个月300-400美金的超市购物卡给老人买菜买药。
不但不用支付任何费用，还每个月送几百美金超市购物卡，难怪听起来像骗人的都一样。
3.为什么这些保险公司每月还会付钱给我呢？他们怎么盈利呢？
首先，当你选择加入某个保险公司的特供医保计划后，联邦政府会从Medicare蓝红卡、州政府会从Medicaid白卡中拨款给保险公司，每个月为每个参保人支付一千多美金的保险费。相当于政府替你支付了保险费，帮你买了保险。以后当你生病需要看病时，医院不再找政府报销费用，而是找保险公司报销了。
而保险公司为了吸引更多人参保他们的保险，得到政府更多的订单，他们就会让渡一些利润推出很多优惠条件，例如让老人吃好健身好，也有助于老人身体健康，这样就医需要少了，保险公司的利润就更大了。
政府让20多家保险公司来分摊这个公共福利项目，互相形成竞争，最终获益的是用户。
4.听起来不错，我动心了。可是以后如果我不喜欢了，我可以退出来吗？不会对我有什么损失吧？
双卡持有者每个季度都有机会更换您的医保计划，从特供医保回到政府的蓝红卡和白卡。如果您一直符合双卡的条件，来回更换不会给你带来任何费用。但是如果你已经失去了政府双卡的资格，还在享受特供医保的，那么要自付腰包补付双卡失效以后的特供医保保费。
5.那这20多家保险公司，我应该挑哪家加入好呢？
最重要的是看你现在的就医需要，吃哪些药，尤其是一些不常见很贵的特效药，不见得每个保险公司都全部报销。所以，你要选择一家保证能够把你一切的医疗需要都覆盖的。
希摩中心计划于12月2日（周六）专门为华裔老人举办特供医保注册专场。橙郡老龄部专门负责老人医保的Jeanne Chamberlin和她的同事，将帮助符合条件的华人老人选择最合适的免费特供医保险种，并注册加入。
如果你同时拥有政府医保双卡（Medicaid白卡+Medicare红蓝卡），我们鼓励你考虑加入这个老人特供医疗保险计划。详情请打老人中文养老服务热线919-245-4275咨询和预约服务。
Special Needs Plans for Dual Eligibles
Many Chinese seniors thought it was “too good to be true” after attending the sales presentation for Blue Cross Blue Shield’s Special Needs Plans for Dual Eligibles at Seymore Center. Therefore, after the event, we specifically consulted Jeanne Chamberlin, Orange County Department on Aging’s specialist in Medicare, to confirm relevant questions about this insurance series.
1. Do you recommend seniors join BCBS’s Special Needs Plans?
I recommend it. I encourage all eligible seniors to choose a Special Needs Plan. But don’t just consider BCBS. In fact, there are over 20 insurers on the market that offer this very good special plans.
2. What exactly are these Special Needs Plans? Why do they have so many benefits?
These Special Needs Plans for Dual Eligibles are special insurance plans designed for seniors who have both Medicaid (low-income insurance, commonly known as the white card) and Medicare (retirement pension insurance, commonly known as the blue red card). **Only seniors who have both cards can enjoy the benefits.**
In addition to not having to pay any monthly fees and getting almost full coverage for medical expenses, these plans also provide several thousand dollars in annual reimbursement for dental, vision, and hearing aid expenses each year. Most surprisingly, they also offer free gym memberships and $300-400 in monthly grocery gift cards for seniors to buy food and medicine.
With no fees, and getting hundreds of dollars in grocery gift cards each month, it’s no wonder it sounds too good to be true.
3. Why would these insurance companies pay me money every month? How do they profit?
First, after you choose to join a special needs plan with an insurance company, the federal government will allocate funds from Medicare and the state government will allocate funds from Medicaid to the insurance company, paying over $1,000 per month in premiums for each insured person. This means the government is paying the premiums for you and buying the insurance on your behalf. In the future when you need medical care, the health providers will seek reimbursement from the insurance company instead of the government.
And to attract more customers and get more business from the government, insurance companies will give up some profits and offer many benefits, such as helping seniors eat well and stay fit, which also keeps them healthier and lowers medical costs, resulting in higher profits for the company.
By having over 20 insurance companies share this public welfare program and compete against each other, the ultimate beneficiaries are the consumers.
4. It sounds good, I’m interested. But what if I don’t like it later, can I opt out? There won’t be any losses for me right?
Dual cardholders have the opportunity to change their health plans every quarter, switching back from the Special Needs Plans to the government’s original Medicare and Medicaid cards. As long as you continue to qualify for the dual cards, switching back and forth will not incur any fees. However, if you have already lost eligibility for the government dual cards but continue to enjoy the Special Needs Plan benefits, you will have to pay out of pocket to cover the premiums after losing the dual cards.
5. So with over 20 insurance companies, which one should I choose?
The most important thing is to look at your current medical needs, medications taken, especially some uncommon and expensive specialty drugs, which may not all be fully covered by every insurance company. So you need to choose one that ensures all your medical needs are covered.
**Seymour Center has scheduled a Special Needs Plan enrollment event specifically for Chinese seniors on December 2 (Saturday).** Jeanne Chamberlin and her colleagues from the Orange County Department on Aging who specialize in senior health plans will assist eligible Chinese seniors in selecting the most suitable free Special Needs Plans and enrolling.
If you currently have dual government insurance cards (Medicaid white card + Medicare red/blue card), we encourage you to consider joining these Special Needs Plans. Please call the Chinese senior helpline at 919-245-4275 for more details and to schedule an appointment.
