California Medicare Plans & Local Agent Expertise

This is everything you need to know about Medicare plans in California as well as an easy way to find a local agent.

Medicare is a federally regulated and funded health care program for seniors and some disabled Americans. Even though it is a federal program, companies are allowed to sell different private plans in every state.

This Guide to California Medicare Includes:

• California Medicare Eligibility Guidelines
• Medicare Plans in California
• What is the Cost of Medicare in California
• Can I Have Medicare and Medicaid in California?
• How do I Apply for Medicare in California?

California Medicare Eligibility Guidelines

There are four ways to qualify for Medicare. You can:

• Be age 65 or older
• Have ESRD (End-Stage Renal Disease)
• Have ALS (Lou Gehrig’s Disease)
• Receive SSDI (Social Security Disability Insurance) for 25+ months.

Why Work With a Local Medicare Insurance Agent in California?

If you live in California, you have a lot of choices when it comes to Medicare. The challenge is figuring out which coverage options actually make sense for you.

Medicare can be very local, especially in a state as large as California. The Medicare Advantage plans, insurance companies, provider networks, and prescription drug plans available in Los Angeles County can look very different from the options available in San Diego, Orange County, Sacramento, the Bay Area, or one of California’s more rural communities.

That is where working with a local Medicare insurance agent can really help.

Our job as Medicare insurance agents is not to tell every California Medicare beneficiary to choose the same plan. It is to help you understand your Medicare coverage options and find coverage that fits your doctors, prescriptions, budget, and healthcare needs.

For some people, that may mean staying with Original Medicare and adding a Medicare Supplement and Medicare Part D plan. For others, it may mean comparing Medicare Advantage plans offered by private insurance companies in their county.

A licensed Medicare agent in California can help you:

• Compare plans and coverage options from multiple insurance companies serving your area
• Review provider networks to see if your doctors, specialists, medical groups, and preferred hospitals participate
• Compare prescription drug plans and formularies based on the medications you take
• Understand your monthly premium, deductibles, copays, and out-of-pocket costs
• Explain how Part A, Part B, Part C, and Part D work
• Compare Medigap plans and Medicare Supplement insurance plans
• Review important enrollment deadlines, including Medicare Open Enrollment and special enrollment periods
• Look at whether you may qualify for programs that can help with certain Medicare costs
• Review your Medicare coverage each year as your health needs, prescriptions, and available plans change

Medicare Help Available to California Residents

Some California Medicare beneficiaries may also qualify for Medi Cal, California’s Medicaid program, or a Medicare Savings Program that can help with certain Medicare costs. If you qualify for both Medicare and Medi Cal, understanding how the two programs work together can be especially important when comparing your coverage options.

California residents also have access to the Health Insurance Counseling and Advocacy Program (HICAP), California’s State Health Insurance Assistance Program, or SHIP. HICAP provides free, unbiased counseling to help Medicare beneficiaries understand Medicare benefits, Medicare Advantage, Medicare Supplement coverage, prescription drug coverage, and other Medicare related issues.

Having a Local Medicare Expert Matters

One of the biggest advantages of working with independent Medicare insurance agents or a Medicare broker is having someone you can actually call when you have a question.

Your plan can change. Your prescriptions can change. Provider networks can change. Insurance companies can change their benefits and costs from one year to the next.

In California, there is another reason local knowledge matters: healthcare can be highly regional. The doctors, hospitals, medical groups, and Medicare insurance options available to you depend heavily on where you live.

Your Medicare coverage should not be something you choose once and forget about.

Working with a local Medicare insurance agent in California gives you someone who understands the Medicare market in your part of the state and can help you compare your options as your needs change.

Medicare Plans in California

Even though there are hundreds of plan options for Medicare in California, there may only be a select few that are available to you and that make sense for your needs. Keep in mind that Original Medicare (the government-sponsored plan) is NOT the same thing as privately owned California Medicare Advantage and Medicare Supplement plans.

Original Medicare is what most people begin with when enrolling in Medicare. It consists of Part A, hospital insurance, and Part B, medical/doctor insurance. Once you have Part A and Part B, most people will make a decision between enrolling in a stand-alone Part D (prescription drug coverage) plan and enrolling in a Medicare Advantage plan with prescription drug coverage.

Medicare Advantage Plans in California

Medicare Advantage plans in California are great options for those who want more benefits. You’ll still have all your Part A and Part B benefits, but also have more! 

Once you decide that you want Medicare Advantage, you’ll have to decide whether or not you want an MAPD, a Medicare Advantage plan with prescription drug coverage. Then, you can look at all of the other benefits that Medicare Advantage plans in California can provide: fitness programs, meal delivery, dental, vision, hearing, non-emergency transportation, etc.

Need help making your California Medicare decision? Make a list of the benefits that you need before you start shopping for plans. Also, make a list of the doctors and pharmacies you like to visit, and the prescriptions that you are currently taking. Make sure that the plan you select will cover all of your needs.

Looking for Medicare help in another state? Connect with a Medicare Agent Near You.

CA Medicare Supplement Plans

If Medicare Advantage isn’t right for you, you may want to consider CA Medicare Supplement plans instead. These plans are often called “Medigap,” because they close the gap between what Medicare covers and your out-of-pocket costs. Medigap plans usually do not include all the extra benefits that Medicare Advantage plans in California can provide. Instead, Medigap plans can cover your Part A and Part B premiums, deductibles, co-payments, and coinsurance.

What is the Cost of Medicare in California?

If you stick to the basics (Part A and Part B), your costs will be standardized. Most people will have premium-free Part A (unless you did not pay Medicare taxes throughout your life). The standard Part B premium for 2019 is $135.50 per month, and the standard deductible is $185 per year. Most people will not pay any less or more, but those numbers can be adjusted based on your income. If you enroll in a Part D plan, your costs will be slightly different based on the plan you choose. However, the standard deductible for 2019 is $415. Premiums can reach as low as $13 or as high as $80 per month.

If you enroll in a California Medicare Advantage or Medicare Supplement plan, you will have a different premium. Some $0 premium Medicare Advantage plans may be available in your area. Keep in mind that if you are not paying a premium, chances are that your deductible and co-payments will be a bit higher.

California’s Prescription Drug Discount Program for Medicare Recipients

Did you know that California Medicare recipients have access to Medicaid-level drug pricing? Regardless of the prescription drug coverage you have, as long as you have your Medicare card to prove that you have coverage, you can get great discounts. When you pick up your prescriptions, show your Medicare card to the pharmacy and ask for the Medi-Cal reimbursement price. If the Medi-Cal price is lower, they can give you that price instead.

Be aware that if you have a great Part D or Medicare Advantage plan, there is a chance that it will actually be cheaper for you to use your Medicare plan than using the Medi-Cal discount. Always make sure that the price is actually lower before going that route. Additionally, know that only pharmacies who accept Medi-Cal coverage can offer this discount price, so your favorite pharmacy may not participate in this program.

Can I Have Medicare and Medicaid in California?

If you qualify for Medicare and meet the income requirements for California Medicaid (Medi-Cal), you can benefit from both programs! Those who qualify for both can even enroll in a dual-eligible special needs plan (DSNP), a type of Medicare Advantage plan designed specifically for those eligible for both programs. DSNPs generally cover most, if not all, of your health care costs.

How do I Apply for Medicare in California?

Ready to apply? Most people will actually be automatically enrolled in Part A upon turning 65. If you are not automatically enrolled, or if it is time for you to enroll in Part B, your options are:

• Visit SocialSecurity.gov
• Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• Visit your local Social Security office
• Download the application you need and mail it in or bring it to your local Social Security office.

If you’ve decided that you want Medicare Advantage or Medigap, your best course of action will be to speak to a licensed agent in your area who can lay out all of your options and help you select the best one.

To find out if there is a Medicare Plan Finder agent near you, and to schedule your no-cost, no obligation appointment, click here or call (833) 567-3163.