Medicare Plan Options
Health care services can be expensive, but by making sure your health insurance adequately covers the services you need, you can save thousands of dollars annually. Original Medicare may be a good option for you if you’re generally healthy and have limited medical needs. Medicare Supplement Insurance or prescription drug coverage can be added to the base policy for more control of your health care costs. For the most comprehensive coverage, California’s Medicare Advantage program may be a good fit.
Original Medicare is the federal health insurance program that you can sign up for when you turn 65. It features two parts that pay for different services. Part A covers expenses, such as hospital stays and hospice, and Part B covers routine and preventative health services, medical supplies, and outpatient care. To use your insurance, you pay a deductible at the beginning of each year before your coverage kicks in. You also pay 20% of the cost of most Medicare-approved services.
Medicare Advantage Plans
Medicare Advantage Plans give you another option for getting Parts A and B coverage. These plans are offered by private health insurance companies and provide at least as much coverage as Original Medicare, but they also often include additional benefits, such as vision and dental insurance and prescription drug coverage. Medicare Advantage’s most popular plan types, HMOs, PPOs, and PFFS plans, may be familiar to you, but the program also includes SNPs for those with qualifying conditions or circumstances. Out-of-pocket costs vary from one plan to another and may include annual medical or prescription drug deductibles, copays, and premiums.
Medicare Prescription Drug Coverage Plans
Medicare prescription drug coverage isn’t automatically included under Original Medicare, but it is optional to add for an additional monthly premium. While it may be tempting to skip this coverage when you initially sign up for Medicare, if you add it later on, you’ll pay a late enrollment penalty every month for as long as you have your policy. To qualify for this coverage, which is also called Part D, you have to have both parts of Original Medicare. There are numerous plans available, so before you sign up for one, it’s a good idea to consider whether you currently take any prescriptions, if most of your prescriptions are for generics and whether you’re willing to choose a plan that requires you to use in-network providers.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance Plans, also called Medigap, are plans provided by private health insurance companies that cut down on your out-of-pocket costs. These plans cover costs, such as copays and coinsurance. All plans cover a portion of the Part A deductible, and plans sold prior to 2020 may cover some of your Part B deductible. Some Medigap plans also provide coverage beyond the scope of Original Medicare, such as medical care when you travel outside of the country.
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|
|3,487,616||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*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
As a California resident, you have access to a range of programs and agencies that provide free information and assistance to help you make educated decisions about your health insurance coverage. Several state agencies provide location-specific information regarding available Medicare Advantage Plans, prescription drug plans, and Medicare Supplement Insurance. The state also has programs that provide advocacy and assistance with signing up for Medicare.
CA Department of Insurance
The CA Department of Insurance has a Senior Information Center that educates you about your health insurance options, changing laws that affect your coverage, and how to stay protected from common health insurance scams. The department provides comprehensive information about Medicare and its scope of coverage, prescription drug coverage, Medicare Supplement Insurance, the state’s Medicare Advantage program, and Medi-Cal, the state’s Medicaid program.
Contact Information: Website | 800-927-4357
Legal Aid Foundation of Los Angeles
The Legal Aid Foundation of Los Angeles is a nonprofit law firm that provides free civil legal services in the Los Angeles region. This agency provides you with expert help in obtaining government benefits, such as nutrition services, Supplemental Security Income, Social Security Disability Income, and Medicare. It can also help you know what to do next if your Medicare policy is canceled or if a claim is denied.
Contact Information: Website | 800-399-4529
Health Insurance Counseling and Advocacy Program
HICAP is a statewide program that provides free, unbiased options counseling to help you understand your post-retirement health insurance options. It’s staffed mainly by trained volunteers who can answer any questions you have about your Original Medicare benefits and available Medicare Advantage Plans. These counselors can help you assess your care needs and find a prescription drug plan that covers your current medications or sign up for a Medigap plan that can reduce your out-of-pocket expenses. HICAP counselors can also help you understand and sort medical bills, dispute billing errors, or appeal denied Medicare claims.
Contact Information: Website | 800-434-0222
County of Los Angeles Workforce Development, Aging and Community Services
WDACS is one of 33 Area Agencies on Aging in California. This agency serves Los Angeles County, the most populous county in the state, through a wide array of programs and services to promote healthy aging. Through this agency, you can connect with HICAP counselors who provide Medicare options counseling. The agency also provides some civil legal aid and can help you sign up for other federal benefits, such as Supplemental Security Income and Social Security. To find your local AAA, follow this link.
Contact Information: Website | 213-738-2600
Learn More from Our Sources
- Medicare | What’s Medicare? | Last accessed May 2021
- Medicare | How Do Medicare Advantage Plans Work? | Last accessed May 2021
- Medicare | Medicare Advantage Plans | Last accessed May 2021
- Medicare | How to Get Prescription Drug Coverage | Last accessed May 2021
- Medicare | Part D Late Enrollment Penalty | Last accessed May 2021
- Medicare | 6 Tips for Choosing Medicare Drug Coverage | Last accessed May 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed May 2021