Medicare is a federal healthcare program that is used primarily by people over age 65. People of any age with disabilities and those with end stage renal disease or Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) are also able to receive Medicare.
If you live in California and meet the requirements for Medicare, you are eligible to obtain original Medicare (parts A and B) and Medicare Part D, no matter where in the state you live. The availability of Medicare Part C (Medicare Advantage) is different in some areas of California than it is in most other states.
Your eligibility for Medicare Part C in California is based on the county and zip code of your primary residence.
California is a large, populous state which contains many Medicare recipients. If you are new to Medicare and live in California, you’re in good company. Here is what you need to know about the various parts of Medicare in your state:
Medicare Part A
Medicare Part A is also known as hospital insurance. Part A covers hospital inpatient care, hospice care, some home health services, and your stay and services in a skilled nursing facility (SNF). If you or your spouse worked and paid Medicare taxes for at least ten years, you will most likely be eligible for premium-free Part A, at no monthly cost. Even if you are not eligible for premium-free Part A, you may be able to purchase Part A (premium Part A), should you choose to.
Medicare Part B
Medicare Part B covers medically-necessary services, such as doctor’s appointments and ambulance services. It also covers preventive care, such as many vaccines. Along with Part A, Medicare Part B makes up original, or traditional Medicare. You will have to pay a monthly premium for Medicare Part B.
Medicare Part C (Medicare Advantage)
Medicare Part C is purchased through private insurers that are approved by Medicare. By law, a Medicare Part C plan must cover at least as much as original Medicare parts A and B, do. Most Part C plans cover more services than original Medicare provides for, but often require that you use a specified network of doctors. Some Medicare Part C plans include prescription drug coverage, but others do not.
Medicare Part C is not available everywhere in California. Some counties have access to many plans. Other counties have access to only a few. Approximately 115 counties in California, such as Calaveras County, do not have access to any Medicare Advantage plans.
If you live in an area where Part C is unavailable, there are other plans available in addition to original Medicare, such as Medigap (Medicare Supplement), to help provide the type of coverage you need.
Enter your zip code here to see Medicare plans available in your area.
Many companies do offer Advantage policies in parts of California. They include:
- Kaiser Permanente Senior Advantage
- Alignment Health
- Blue Shield
Many of the plans offered are Health Maintenance Organization (HMO) plans that start at a $0 monthly premium. The maximum out-of-pocket costs you are required to pay annually can vary significantly for these plans, from $800 to $4,000, or more. HMO plans typically also require that you pay a copay at each doctor’s visit.
Other types of Medicare Advantage plans include Preferred Provider Organization (PPO) plans. Some of these may have higher monthly premiums than HMOs in addition to out-of-pocket costs and copays. It is important to review the plans you are considering, as they vary not only in cost but also in the services and coverage provided.
Medicare Part D
Medicare Part D is the part of Medicare that covers prescription medications. It is meant to be used with original Medicare (parts A and B). If you have an Advantage plan that includes medications, you will not need to purchase a Part D plan as well.
If you don’t have prescription drug coverage through another source, such as the health insurance you get at work, it is important to enroll in Medicare Part D when you are first eligible for Medicare. If you don’t, you may have to pay higher rates in the form of a monthly penalty for the entire duration of your Part D coverage.
Medicare Part D is provided by private insurance companies. There are Part D plans available throughout the entire state of California. These plans vary in terms of the medications they cover, as well as their cost.
Help enrolling in Medicare in California
With so many options, enrolling in Medicare can be confusing. These organizations can provide information you need to choose and enroll in the best Medicare plan for you if you live in California.
Medicare Supplement (Medigap)
Medicare supplement insurance is designed to help you pay for the things not covered by original Medicare. These costs include copays, coinsurance, and deductibles. In California, you are able to purchase one of 10 types of standardized plans that are available throughout most of the country.
These standardized plans are designated by alphabet letters: A, B, C, D, F, G, K, L, M, and N. Each plan varies in terms of its deductibles, cost, and coverage. In California, there are many insurers that cover some or all of these plans. Their costs within plans tend to be the same or very similar.
Some companies that offer Medigap in California include:
- Health Net of California
- Sterling Life Insurance Company
- Humana Insurance
- Blue Shield
In Los Angeles, monthly premium rates range anywhere from $45 – $300 or more, within each type of plan. Some plans also require that you pay a percentage of the costs for services covered under Part B, plus a Part A deductible.
There is a six-month open enrollment period during which you can get Medigap. This period typically starts on your 65th birthday, and coincides with your enrollment in Medicare Part B. In most of the country, this is the only period of time during which you can enroll in a Medigap plan and be assured of getting one, no matter what type of health issues you have. However, in California, you are allowed to switch to a different Medigap plan with guaranteed issue during the 30 days following your birthday each year, provided the new plan gives you equal or lesser coverage than your current Medigap plan.
If you live in Los Angeles zip code 90210, there are 60 or more different Medicare Advantage plans available. Here are samples Medicare Advantage plan rates in your zip code:
- Kaiser Permanente Senior Advantage: $0 monthly premium in addition to your Part B premium, $0 deductible, and $4,000 maximum out-of-pocket costs. You will pay a $5 copay per doctor’s visit for your primary care physician and a $15 copay for a specialist.
- Alignment Health Plan Premium: $0 monthly premium in addition to your Part B premium, $0 deductible, and $1,499 maximum out of pocket costs. There are no copays for doctor visits.
- Scan Classic: $0 monthly premium in addition to your Part B premium, $0 deductible, and $899 maximum out of pocket costs. There are no copays for doctor visits.
If you live in San Francisco zip code 94016, there are 16 Advantage plans available with premiums that range from $0 to $398 per month. Some sample Medicare Advantage plan rates in this zip code include:
- Anthem MediBlue Plus: $0 monthly premium in addition to your Part B premium, $0 deductible, and $4,500 maximum out of pocket costs. You will not have a copay for your primary doctor but will have to pay a $25 copay for a specialist.
- Brand New Day Classic Care: $0 monthly premium in addition to your Part B premium, $0 deductible, $999 maximum out of pocket costs. You will not have a copay for your primary doctor but will have to pay a $10 copay for a specialist.
If you live in Oak Glen zip code 92399, there are nearly 50 Medicare Advantage plans available. Some sample Medicare Advantage plan rates in this zip code include:
- Health Net Gold Select: $0 monthly premium in addition to your Part B premium, $0 deductible, $899 maximum out of pocket costs. You will not have a copay charge for any doctor visits.
- Kaiser Permanente Senior Advantage Inland Empire: $0 monthly premium in addition to your Part B premium, $0 deductible, $4,000 maximum out of pocket costs. You will have a $15 copay for your primary doctor and a $25 copay for specialists.
There are many, many more plans to choose from in certain locations. Keep in mind that providers also offer multiple types of plans for you to view and consider.
No matter which type of plan you decide is best for you, you will have to enroll during specific time periods. These enrollment dates are national, and the same in California as in every other state.
The deadlines for Medicare enrollment in California are the same as they are in the rest of the country, with the exception of Medigap, which has additional enrollment periods:
|Type of enrollment||Dates||Requirements|
|Initial enrollment||3 months before and after your 65th birthday||This is the first time most people are eligible to enroll in original Medicare (parts A and B).|
|General enrollment||Jan. 1 –March 31, 2020||If you miss initial enrollment, you can sign up for Medicare now, but your rates may be higher.|
|Special enrollment||at the time of change in your Medicare status and for eight months after||You can enroll now if you have personal changes in your current health plan, such as losing your health insurance at work, losing coverage through your spouse, or if your Medicare health plan is no longer available in your zip code area.|
|Open enrollment||Oct. 15 — Dec. 7, 2020||You can change your current plan to a different one and add or drop services.|
|Medicare Supplement (Medigap) enrollment||Starts on your 65th birthday and lasts for six months.||In California, you can change your Medigap plan during the month following your birthday each year.|
|Medicare Part D enrollment||April 1 — June 30, 2020 (or Oct. 15 — Dec. 7, 2020 for changes)||You can get Medicare Part D during your first initial enrollment period or during general enrollment. It can also be added to your coverage from April 1-June 30 your first year. Changes to Part D can be made from October 15 – December 7 annually after your first year of coverage.|
|Plan change enrollment||Oct. 15 — Dec. 7, 2020||You can join, drop, or switch Medicare parts C or D any year during this plan change enrollment period.|
Medicare is a federal insurance program that is available in California for those who are eligible. Medicare Advantage (Medicare Part C) is not available throughout every zip code in the state. However, original Medicare (parts A and B), as well as Medicare Part D and Medigap are available in every county and zip code.
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