Your Medicare Options In California
There are many options for Medicare in California. Read this quick guide to learn about eligibility and how to sign up online.
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4.5 million Californians are enrolled in Medicare
In 2020, more than 370 Medicare Advantage plans are available in California
The average Medicare Advantage premium in 2020 is $22.16 per month in California
32 Part D drug plans are available in California for 2020
Make a Smart Choice for Medicare in California
The Golden State lives up to its reputation when it comes to Medicare options. California has some of the lowest out-of-pocket maximums and monthly premiums for Medicare Advantage plans.
It's also one of the 47 states with standardized Medicare Supplement insurance policies, so it's easy to find a Medicare plan that meets your needs in California.
As an independent health insurance agent, many of my clients live in California. When I work with clients, most of them have some understanding that they need coverage beyond Original Medicare. They already know Medicare won't cover everything. Besides services that just aren't covered, I walk people through the costs they'll be expected to pay under Original Medicare. These expenses can include:
Deductibles (Parts A and B)
Besides these gaps in Original Medicare, I want to make sure my clients know there is no cap on spending, unlike with traditional private health insurance. The last major gap I talk about is prescription drug coverage.
Original Medicare won't cover prescriptions, so you'll need to look to other options for help there. All of these gaps lead most people to choose a private Medicare plan option.
What are the Medicare Plans in California?
The great news is you have literally hundreds of options for Medicare in California. The three major choices are:
Medicare Supplement insurance, also called Medigap insurance
Medicare Advantage plans, also known as Part C
Prescription drug plans, also known as Part D
All of these plans are offered by private insurance companies. Medicare Supplement insurance plans work with Original Medicare by closing some or all of the gaps in Part A and B. Some of the more popular Medigap companies in California include United Healthcare and Blue Cross Blue Shield.
Medicare Advantage Plans in California
Medicare Advantage plans are an alternative to Original Medicare. When you enroll in Medicare Advantage, you're actually leaving Original Medicare. You can only return to Original Medicare during specific times of the year, like the Annual Enrollment Period.
Medicare Advantage plans close the Parts A and B coverage gaps by charging relatively small copayments and coinsurance for each service or procedure you receive. It's important to keep in mind, though, that Medicare Advantage plans do have an annual cap on spending. So, many of my clients choose Medicare Advantage to put a cap on their out-of-pocket spending.
The last plan type I help my clients with is Part D prescription drug plans (PDP). These plans only cover prescription drugs; you remain in Original Medicare, and none of the other gaps are closed unless you also enroll in a Medigap plan. Almost none of my clients have only PDPs.
What is Medicare Eligibility in California?
Eligibility for Medicare in California is identical to federal rules and regulations. There are two types of criteria for eligibility:
Citizenship or Permanent Legal Resident status
Age, disability or health triggers
As long as you are a US citizen or Permanent Legal Resident, you will be eligible for Medicare. When you enter the program depends on which qualification you satisfy. Most people enter Medicare at age 65, but you can enter earlier if you receive disability income from Social Security or the Railroad Retirement Board for 24 consecutive months. You can also enter early if you're diagnosed with ALS (Lou Gehrig's disease) or ESRD (end-stage renal disease).
Once you've signed up for Original Medicare Parts A and B, you can enroll in the Medigap, Medicare Advantage or drug plan of your choice during your Initial Enrollment Period.
How to Apply for Medicare Online in California
Even before the COVID-19 pandemic, I advised people to sign up for Medicare online. This is especially important during these times of social distancing. It's very helpful if you sign up for Medicare during the three months before your 65th birthday. At a minimum, I urge my clients to enroll in Part A before they turn 65.
If you enroll during the three months prior to your 65th birthday you can sign up on the Social Security Administration's secure website. This is critical, because if you're already enrolled in Part A it's very easy to enroll in Part B at a later date. But, if you don't enroll in Part A before your 65th birthday you may need to go to a Social Security office to sign up.
You can also enroll in the private Medicare plan of your choice online. One of the best ways to do this is by working with an independent insurance professional. All the major private insurance companies accept online applications, so you can work with an agent to sign up for the plan of your choice without meeting face-to-face.
Joseph Arroyo is a licensed Medicare insurance specialist who lives in Hilton Head, South Carolina. Arroyo is certified to sell Medicare products including Medicare Supplement insurance, Medicare Advantage, and prescription drug plans.