Understand Medicare in California
Medicare, the United States federal medical insurance program, provides coverage for more than 6.5 million people in California who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $506per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 492 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in California.
Connect with a licensed sales agent to go over your Medicare Plan options: Request a Quote
Medicare Plans in California
Compare ratings of California’s Medicare plan providers: | ||||
Insurance company | Medicare rating | A.M. Best rating | BBB rating | J.D. Power ranking |
Aetna | 4 stars | A+ | A+ | 6th out of 9 |
Anthem Blue Cross Blue Shield | 4 to 4.5 stars | A+ | A+ | 5th out of 9 |
Cigna | 4 stars | A- | Not rated | 8th out of 9 |
Humana | 4 stars | A- | A+ | 2nd out of 9 |
Kaiser | 5 stars | A | A- | 1st out of 9 |
UnitedHealthcare | 3.5 stars | A+ | A- | 4th out of 9 |
Medicare Plan Options in California
Residents of California have multiple Medicare plans to choose from. Many are tiered to help California residents find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. California’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
Original Medicare (Parts A and B) | Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|
Medicare Advantage Plans (Part C) | Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|
Medicare Prescription Drug Coverage Plans (Part D) | Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|
Medicare Supplement Insurance Plans (Medigap) | Some California seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
|
Medicare in California by the Numbers
People enrolled in Original Medicare | Average plan cost | Annual state spending per beneficiary | Spending per beneficiary compared to the national average |
3,503,899 | Plan A: $0 to $506 per month*
Part B: $164.90 per month** |
$13,797 | +19.3 |
*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.
Medicare Resources in California
Getting support can help when you’re making Medicare decisions. California has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as the California Health Insurance Counseling and Advocacy Program (HICAP). HICAP has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
California Association of Area Agencies on Aging (AAA)
California Association of Area Agencies on Aging can connect you with one of its regional agencies, all of which provide a comprehensive selection of services for the region’s older adults. The agencies 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.
Contact information: Website | (916) 443-2800
California Department on Aging
The Department offers HICAP Medicare counseling services to help you navigate the program and Medicare Advantage plans. HICAP counselors are trained in Medi-Cal and Medicare and can help you understand the complex insurance options to find the best fit for you.
Contact information: Website | (800) 434-0222
California Health Advocates
California Health Advocates provides information about Medicare, including Part D prescription coverage, and how to access financial aid. This resource offers Medicare information organized by topic, with English and Spanish podcasts available in several sections. The group also supports HICAP.
Contact information: Website | (916) 231-5114
Health Services Advisory Group
If you already have Medicare, you can turn to the Health Services Advisory Group with any complaints about quality of care, delays in care, or other issues.
Contact information: Website | (818) 409-9229 or (415) 897-2400