Know your options for Medicare plans in California, whether you’re looking for Original Medicare or Medicare Advantage.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
California has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$170.10 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
California Medicare Advantage programs have networks and may only be available in certain areas of California. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in California is $18.12 (in 2022).
The California Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. California has 458 plans available in 2022. Medicare Advantage has continued to rise in popularity with Californians.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||Better Business Bureau (BBB) rating||National Committee for Quality Assurance (NCQA) rating||J.D. Power ranking|
|3.9 stars||A||F||Not rated||Fifth out of 10|
|3.9 stars||A||B||3 to 3.5 stars||Eighth out of 10|
|5 stars||A+||A-||4 to 4.5 stars||First out of 10|
|4 stars||A||B-||3 stars||Not ranked in the top 10|
|4.2 stars||A||Not rated||3.5 to 4 stars||Seventh out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|Aetna Medicare Elite Plan (PPO)||$0||$0||Health: $750
|Wellcare Patriot Giveback (HMO)||$0||$0||Health: $0
|AARP Medicare Advantage SecureHorizons Focus 2 (HMO)||$0||$0||Health: $0
Plans calculated based on Sacramento ZIP code 94203.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
California Part D premiums start at $7.70 a month.
Currently, there are 22 stand-alone PDPs in California. Eight of the stand-alone plans and 244 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|3.8 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|4 stars||A||Not rated||2.5 to 3.5 stars||Third out of 10|
|4.2 stars||A||A+||2.5 to 4 stars||Seventh out of 10|
|3.7 stars||Not rated||A-||2.5 to 3.5 stars||Ninth out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartRx (PDP)||$7.70||$53.90||$480|
|Wellcare Value Script||$12||$83||$480|
|Humana Walmart Value RX||$22.70||$158.90||$480|
Plans calculated based on Sacramento ZIP code 94203.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 14 standardized plans available in California designated by different letters of the alphabet (A, B, C, D, F, G, H, I, J, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to January 1, 2020.
A Plan G for a 65-year-old nonsmoking female in Sacramento ranges from $120 to $196 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Plan F||$150 to $293||$0||$0 hospital (Part A)
$0 medical (Part B)
|Plan G||$120 to $196||$0||$0 hospital (Part A)
$233 medical (Part B)
|Plan N||$92 to $189||$0 Generally, your cost for approved Part B services with
You pay $20 for some office visits and $50 for emergency services that don’t result in a hospital admission
|$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in Sacramento ZIP code 94203.
Californians have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual California spending per beneficiary||Spending per beneficiary compared to the national average|
|6,487,954||Part A: $0 to $499 per month*
Part B: $170.10 **
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in California. The organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. An example is the California Association of Area Agencies on Aging, which have programs designed to help seniors 60 and older maintain their health and independence, including resources to guide you through the Medicare enrollment process, and the counselors will help you understand the available benefits fully.
Never be afraid to ask questions. Get started with these California Medicare resources:
|Organization||How you can get help||Contact Information|
|California Association of Area Agencies on Aging||Connect with one of its regional agencies, all of which provide a comprehensive selection of services for the region’s older adults.They provide assistance, legal information, referral, and support.||Website | (916) 443-2800|
|California Department on Aging||Receive counseling services to help you navigate the program and Medicare Advantage plans.||Website | (800)434-0222|
|California Health Advocates||Provides information about Medicare, including Part D prescription coverage, and how to access financial aid.||Website | (916)231-5114|
|Health Services Advisory Group||Helps resolve Medicare complaints about quality of care, delays in care, or other issues.||Website | (818)409-9229
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
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Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.