Products

Medicare

Medicare is a federal government social insurance program that guarantees access to health insurance for certain Americans and legal residents aged 65 and older, and younger people with disabilities, and people with end stage renal disease.In most Medicare Advantage HMOs, patients generally must get their care and services from the plan’s network. Members of Medicare Advantage plans will be asked to choose a primary care doctor. Members that get health care outside of the plan’s network may have to pay for these services. In some cases, neither the Medicare HMO nor the Original Medicare Plan will pay for these services. Medicare HMO plans contracted with Preferred IPA of California will operate much like the Medi-Cal and Healthy Families contracts.

In 2005, Medicare Health Plans started to offer “Special Needs” Plans. These plans may limit all or most of their membership to people in certain long-term care facilities (like a nursing home), eligible for both Medicare and Medicaid, or with certain chronic or disabling conditions. Special Needs Plans are available in limited areas. The Special Needs Plan must be designed to provide Medicare health care and services to people who can benefit the most from special expertise of the plan’s providers, and focused care management. Special Needs Plans also must provide Medicare prescription drug coverage.

In most of these plans, generally there are extra benefits and lower co-payments than in the Original Medicare Plan. For example, a Special Needs Plan for people with diabetes might have additional providers with experience caring for conditions related to diabetes, have focused special education or counseling, and/or nutrition and exercise programs designed to help control the condition. A Special Needs Plan for people with both Medicare and Medicaid might help members access community resources and coordinate many of their Medicare and Medicaid services.
To learn more about Preferred IPA of California’s Medicare programs visit our Medicare page here.

Medi-Cal

Medi-Cal is a federally and state-funded health insurance program for qualified low-income, elderly and disabled persons. The program provides no-cost comprehensive health, dental and vision benefits, with no monthly premiums and no co-payments. The Medi-Cal program in Los Angeles County includes members in both the original fee-for-service model and the managed care model. Over 50 percent of the county’s Medi-Cal recipients receive services through the managed care model.

Los Angeles County operates under the Medi-Cal managed care Two-Plan Model, with L.A. Care Health Plan as the Local Initiative plan and Health Net as the Commercial or Mainstream plan. L.A. Care has the following Plan Partners through which the Medi-Cal patients are assigned: Blue Cross of California, Care 1st Health Plan, Community Health Plan, and Kaiser. HealthNet has Molina as its Medi-Cal partner. Preferred IPA of California contracts with most of the Local Initiative and Commercial plans. Providers have the opportunity to affiliate with these health plans through Preferred IPA of California.

For more information about this program, please Contact Us.

Healthy Kids

L.A. Care administers the Healthy Kids program, which provides health coverage to children up to age 18. The program is offered by L.A. Care Health Plan and is sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles. Healthy Kids covers children:

  • Up to their 19th birthday
  • Who are Los Angeles County residents, U.S. citizens, nationals, eligible qualified immigrants, or undocumented persons who meet all other eligibility requirements
  • In families whose incomes are at or below 300% of the Federal Income Guidelines
  • Who are not eligible for no-cost full-scope Medi-Cal, Healthy Families, and Access for Infants and Mothers (AIM)
  • Who have not been covered by private (employer-sponsored) health insurance in the last three months

For more information about this program, please Contact Us.

Healthy Families

The Healthy Families program offers low-cost health, dental and vision coverage to children under the age of 19 who are not eligible for Medi-Cal and who do not have private insurance. Preferred IPA of California is participating in the Healthy Families Program through several of our contracted health plans including Anthem Blue Cross and HealthNet.

The Healthy Families Program requires co-payments for certain office or home visits. There is a $250 co-pay maximum in a benefit year for the member. No co-payment shall be charged for preventive services, including services for the detection of asymptomatic diseases. In addition, no co-payment shall be charged to members under 24 months of age for well baby care, health examinations and other office visits. Co-payments also cannot be charged for the following services:

  • Periodic Health Exams
  • A Variety of Voluntary Family Planning Services
  • Prenatal Care
  • Vision and Hearing Testing
  • Immunizations
  • Venereal Disease Tests
  • Cytology Examinations (on a Reasonable Basis)
  • Health Education Services

For more information about this program, please Contact Us.