TABLE OF CONTENTS
Medicare is the federally backed health insurance program for older Americans who turn 65. Those who have disabilities or specific illnesses may also qualify at a younger age. New enrollees can choose Original Medicare, which is administered by the federal government, or Medicare Advantage, which is offered via private health insurance companies. Medicare Advantage is also known as Medicare Part C or referred to as MA, and plans must follow federal guidelines.
For those who become Medicare-eligible, it’s a good idea to review all options, including Medicare Advantage plans offered in their state. Often, MA plans may have additional coverages that aren’t offered by Original Medicare. While plans vary by county, all California residents have at least several options from which to choose.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
With 458 Medicare Advantage Plans available in California, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With 43% of eligible California residents opting for a Medicare Advantage Plan, it’s more popular in the Golden State than anywhere else in the nation. California offers the second most MA plans in the nation.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 to March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 to December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 to March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which California Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
California-wide Medicare Advantage Resources
|Resource||Contact||How they help|
|CA.gov – Department of Health Care Services||Phone: (888) 452-8609
email: [email protected]
|The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care|
|California Department of Insurance||Phone: 800-927-4357||CDI enforces the insurance laws of California and has authority over how insurers and licensees conduct business in California|
|California Health Advocates||Phone: 800-434-0222||California Health Advocates is the leading Medicare advocacy and education non-profit in California|
Local Medicare Advantage Resources
|Resource||Contact||How they help|
|LACounty.gov – Department of Public Social Services||Phone: 866-613-3777||A guide to services available to residents of LA county|
|OaklandCA.gov – Medicare and the Annual Enrollment Period||Phone: 510-615-5566||This site offers an overview of eligibility, costs, benefits, and changes in Medicare Parts A and B|
|San Francisco Health Service System||Phone: 800-541-2266||A guide to services available to residents of San Francisco|
Federal Medicare Advantage Resources
|Resource||Contact||How they help|
|American Hospital Association – Medicare Advantage||Phone: 800-424-4301||AHA ensures that members’ perspectives and needs are heard and addressed in national health policy development, legislative and regulatory debates, and judicial matters|
|CMS.gov – Medicare Advantage Applications||N/A||A guide to managing Medicare eligibility and enrollment|
|Medicare.gov – Medicare Advantage Plans||Phone: 800-633-4227||This is the main website for applying for (or making changes to) your Medicare coverage|