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Medicare in California

If you’re close to celebrating your 65th birthday, now’s the perfect time to learn how Medicare can support your ongoing health care. 

Whether still employed or enjoying retirement, California residents must recognize the ins-and-outs of Medicare to save money further along the road.

Of course, changes to health care coverage can be overwhelming, but that doesn’t mean you should put it off. Truth is, Medicare isn’t as complicated as it might seem, and with our experts by your side, we’ll find a plan to match your needs and budget. 

Read on as our experts explore Medicare Supplement Insurance and Medicare Advantage plans in California. 

Medicare in California

Overview of Medicare in California

With almost 40 million residents, California is the most populous state in the U.S. Indeed, California holds the most Medicare beneficiaries, too. Of the 60 million Medicare beneficiaries, around 10% are Californian. 

2020 California Medicare statistics:

  • Close to 7 million Medicare beneficiaries live in California
  • More than 2.7 million California beneficiaries are enrolled in a Medicare Advantage or other Medicare health plan
  • More than 2.3 million California beneficiaries are enrolled in a stand-alone prescription drug plan.

Medicare Supplement Insurance in California

Original Medicare (Part A and B) comes with out-of-pocket costs that the plan holder is responsible for. Medicare Supplement Insurance plans (Medigap) fill in these gaps, covering a portion of the expenses not included by Original Medicare, including deductibles, copayments, and coinsurance. 

Some California Medicare Supplement Insurance plans offer additional benefits, such as emergency medical care outside the U.S.

Medicare Supplement plans in California only work with Original Medicare and are not compatible with Medicare Advantage. Supplement plans also cannot provide coverage for prescription drugs, or routine dental, vision, and hearing care; however, it is possible to purchase these services from insurers as add-ons. 

When to Apply for California Medicare Supplement Insurance?

Californians with Original Medicare can purchase Medicare Supplement Insurance (Medigap) in California during their open enrollment. The open enrollment period is a six-month window that starts on the first day of the month you turn 65, and enrolled in Part B.

It is beneficial for the plan holder to enroll in Medicare Supplement Insurance during this period because they will not be subject to medical underwriting. This means insurers are unable to charge higher premiums or deny coverage based on medical conditions. 

A unique feature of a Medicare Supplement insurance plan in California is the “birthday rule” which, unlike many other states, allows Californians to purchase a new plan around their birthday every year. 

Types of Medigap Plans in California

BenefitsMedigap plans
ABCDFGKLMN
Part A coinsurance and coverage for hospital benefits
Part B coinsurance or copayment50%75%
Blood (first 3 pints)50%75%
Hospice care coinsurance or copayment50%75%
Skilled nursing facility care coinsuranceXX50%75%
Part A deductibleX50%75%50%
Part B deductibleXXXXXXXXXX
Part B excess chargeXXXXXXXXXX
Foreign travel exchange (up to plan limits)XX80%80%80%80%XX80%80%
Out-of-pocket limit $5,800$2,940

 

California Medigap Birthday Rule

The birthday rule allows California Medicare beneficiaries to change Medicare Supplement Insurance (Medigap) plans around their birthday every year.

Californians can change their Medigap plan 30 days before their birthday and up to 30 days after their birthday – giving beneficiaries a 61-day window. The benefit of changing plans during this period is that you cannot be denied coverage or charged higher premiums based on health conditions. 

To take advantage of the birthday rule, Californians must already be enrolled in a Medigap plan, and must not change to a higher-level plan with more coverage. For example, you cannot go from Plan B to Plan C, but you could move from Plan G to Plan N or stay on the same plan-level. 

Outside of the annual birthday open enrollment period, Californians can apply for a new Medigap policy at any time. However, doing so means insurers charge higher premiums or deny coverage based on medical conditions. 

Medicare Advantage Plans in California

Medicare Advantage plans in California include the same coverage as Original Medicare, but, in addition, may cover services, such as vision and dental services. This offers beneficiaries the convenience of having all benefits under a single plan. 

Unlike Medigap plans, Medicare Advantage plans replace your Original Medicare coverage, and you’ll get the benefits through your Medicare Advantage plan, instead of through the federally administered program.

Part D Coverage with California Medicare Advantage

Alongside hospital and medical coverage (Part A and B), some Medicare Advantage plans in California provide prescription drug coverage (Part D). Medicare Advantage plans including this coverage are known as Medicare Advantage Prescription Drug plans. 

Medicare Part C holders should get prescription drug coverage through a Medicare Advantage plan instead of a Medicare Prescription Drug Plan (Part D). If you join a Part D plan while enrolled in a Medicare Advantage plan, you’ll be disenrolled and returned to Original Medicare. 

California Medicare FAQ

How many Part D Plans are available in California?

In California, there are over 32 Medicare Part D Plans available, from 12 different insurers. The monthly premiums range from around $20 up to around $100. The number of plans and cost of premiums changes from year to year.

What are the best California Medicare Supplement Plans?

Medicare Supplements Plan F and Plan G provide the most comprehensive coverage. You can compare the benefits of Plan F and G here.  

Who Can Apply for Medicare in California?

Californians are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis.

If you have any questions about California Medicare in 2020, and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you. Call us today at 1-844-236-0228.

Interested in a quote for California Medicare Insurance? Call 1-844-236-0228 to speak with a licensed agent. 

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