Medicare plays a key role in providing health and financial security to beneficiaries residing in California. California has more than 6.3 million beneficiaries enrolled in Medicare. In fact, more than 10% of ALL Medicare beneficiaries live in California! We’ll cover some very important information below about Medicare in California. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in California?

Medicare covers most California residents who are 65 or older, and it also covers disabled California residents. In general, Medicare enrollment in California works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

California Medicare Enrollments

3,484,773

Original Medicare Plans
(Part A and B)

2,898,922

Medicare Advantage & Other Health Plans

5,108,731

Stand-alone Medicare
Part D (Drug plans)

6,383,695

Total Medicare Beneficiaries
in California

California Medicare Advantage Plans (Part C)

More than 44% of California Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in California who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, there are 372 Medicare Advantage plans available in California. The average monthly Medicare Advantage premium changed from $24.49 in 2019 to $22.16 in 2020. California Medicare Advantage plans may often have lower premiums than Medigap plans.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 2,898,922 beneficiaries enrolled in Medicare Advantage and other plans in California. More than 44% of California Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

California Medicare Supplement (Medigap) Insurance Plans

Medigap insurers are required to offer coverage to California beneficiaries under 65, but not if they have end-stage renal disease.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Since California has an expanded Medicare Advantage enrollment period, fewer people have Original Medicare, and Medigap plans can only be used with Original Medicare. That’s why there’s a low amount of Medigap insurers in California despite the state’s large population of Medicare beneficiaries.

California Medigap enrollees have a 30-day window each year, following their birthday, when they can switch to any other Medigap plan with equal or lesser benefits, without medical underwriting.

California’s “Special” Birthday Rule for Medigap Plans

Once you turn 65, you are eligible for Medicare in California. Your initial enrollment period begins three months before your birth month and lasts through three months after your birth month. During your initial enrollment period, California beneficiaries can apply for any Medigap plan they choose and can’t be turned down for health conditions since it’s not required to answer health questions on your application.

This is the best time to enroll in a California Medigap plan. If you miss this window, you’ll likely have to answer health questions to apply. Though you could be turned down by other California Medigap plans, California allows you to have a second shot at applying without health questions. 

Medicare beneficiaries in California can enroll in a Medigap plan during the days leading up to their birthday and the days directly after their birthday. The birthday rule takes effect 30 days before your birthday and ends 30 days after your birthday. This mean you have a total of 61 days to change Medigap plans.

Moreover, you can’t be denied for health conditions during this window. However, you must already be enrolled in a California Medigap plan in order to take advantage of the birthday rule. You have the choice to keep the same plan type or choose one of the California Medigap plans with fewer benefits. In a nutshell, California Medigap enrollees have a 30-day window each year, following their birthday, when they can switch to any other Medigap plan with equal or lesser benefits, without medical underwriting. This does not apply to Medicare Advantage plans. Before enrolling in a California Medicare Advantage plan, it’s important to keep in mind that if you choose that type of plan you might not be eligible for the waived-underwriting on a new Medigap policy later on.

Lastly, outside of your annual birthday open enrollment, you’re still able to apply for a Medigap plan at any time. Just remember, you’ll be required to go through the normal health underwriting process.

 

California Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, there are 2,323,680 Medicare beneficiaries in California enrolled in Part D plans and 2,795,421 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 30, Part D plans available in California, with premiums ranging from about $13 to $118 per month.

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in California

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of California. Our process makes it easier for you to access your Medicare eligibility in California so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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