California Medicare Guide

Schedule a free consultation with one of our licensed California Medicare Advisors or give us a call at (888) 604-0055 to get started.

Learn the basics you need to know about Medicare in California. Get to know your options and when to enroll.

Use this table of contents to jump to specific sections of the California Medicare guide:

• A Snapshot of Medicare in California

• Medicare Eligibility and Enrollment Steps

• California Medicare Advantage Plans

• California Medicare Supplement Plans

• California Medicare Part D Plans

• Get help paying for Medicare in California

A Snapshot of Medicare in California

There are 6.5 million California Medicare beneficiaries, making up 17% of the state’s total population. Most beneficiaries are on Medicare due to age, but about 9% are on Medicare due to disability. 23% of Medicare enrollees also receive full or partial Medicaid benefits. 53% of Medicare beneficiaries are on Original Medicare and 47% are on a Medicare Advantage plan.

California Medicare Eligibility and Enrollment Steps

US citizens 65 and older are eligible for Medicare. Some individuals who are under 65 years old and have certain disabilities like ALS or End-Stage Renal Disease are also eligible.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

If you’re turning 65 soon, you’re able to enroll in Medicare up to three months before the month you turn 65, at the start of your Initial Enrollment Period (IEP). Your IEP is a seven-month window of time that starts three months before the month you turn 65 and lasts until three months after. You may choose to delay Part B enrollment because you’re still working. If you do, just be sure you meet the requirements for a Special Enrollment Period. 

2. Compare additional coverage options

Once you’re enrolled in Original Medicare, you can choose to stay on Original Medicare or enroll in a Medicare Advantage plan. Both options have their pros and cons, and we’ll explore those a bit later. Just know that the choice you make is a personal one. You shouldn’t pick based on what your spouse or a good friend has, but rather your own health and financial needs. If you ever have any questions about your Medicare options or need advice, our licensed California Medicare Advisors are here for you! Schedule a free consultation or give us a call at (888) 604-0055 to get started.

3. Get the most value from Medicare

To ensure you get the best value from Medicare, you need to use your coverage. Even if you don’t currently need to visit the doctor for an ailment, schedule preventive care appointments and be sure to share your updated insurance information with your pharmacy. 

In addition to using your coverage, you should also review it each year. We’ll help you do this during Medicare’s annual Open Enrollment Period that occurs every year from October 15 - December 7. During this time, we’ll review any changes to your healthcare needs and Medicare coverage, and verify that your coverage is still optimized! 

California Medicare Advantage Plans

California Medicare Beneficiaries have access to 330 Medicare Advantage (MA) plans, but pricing and availability varies by county. For example, LA County has 67 MA plans with monthly premiums ranging from $0 to $87. Alameda County has 35 MA plans with premiums ranging from $0 to $133.

Medicare Advantage is commonly called the all-in-one approach to Medicare. These plans combine Part A, Part B, and usually Part D. They also tend to provide additional benefits, like vision, dental, hearing, and transportation services. MA plans are popular because of these extra benefits paired with no or low additional premiums—although some people misunderstand that they still need to pay their Original Medicare premiums when they choose an MA plan. 

Who wouldn’t want more services covered at no additional cost? You may be wondering why everyone doesn’t choose to enroll in Medicare Advantage. Unfortunately, there are some disadvantages that come with Medicare Advantage, including limited provider networks, pre-authorization requirements and denials, and higher out-of-pocket costs (compared to Original Medicare + a Medicare Supplement plan). 

California Medicare Supplement Plans

There are ten different Medicare Supplement (Medigap) plans available to Medicare beneficiaries. These plans are labeled by letters A through N, and each plan of the same letter (e.g., all Plan Ns) are identical in coverage. Pricing will vary based on your location, the insurance carrier, and your smoking status. 

Many Medicare beneficiaries choose to add Medigap coverage alongside Original Medicare to help cover the 20% of costs that Original Medicare doesn’t pay. These plans significantly reduce your out-of-pocket costs (some almost eliminate them!). 

Three key benefits of Medigap plans that you don’t get with Medicare Advantage are:

• No networks

• No prior authorization requirements

• Lower out-of-pocket costs

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. Your Medigap Open Enrollment Period starts the month after your Part B effective date and lasts for six months. During this time, you have a guaranteed issue right. This means that insurance companies cannot deny you Medigap coverage based on your health history—they can’t even ask you about it! Outside of the Medigap Open Enrollment Period and a handful of other guaranteed issue periods, insurance carriers may ask you questions about your health history, and may reject your Medigap application.

California is one of a handful of states with a Medigap Birthday Rule. This rule allows current Medigap plan holders to switch to another Medigap plan each year during the 60 days following their birthday. If Medigap plan holders choose to switch to a plan with equal or lesser benefits compared to their existing policy (e.g., from Medigap Plan G to Plan N), insurance companies cannot ask health history questions or establish a coverage waiting period. 

California Part D Plans

Original Medicare does not include prescription drug coverage. If you’re on a Medicare Advantage plan, there’s a good chance it includes prescription coverage. If your MA plan doesn’t include it or you’re on Original Medicare, you can get a stand-alone Part D (prescription drug) plan. California Medicare beneficiaries can choose from 26 Part D plans. Like with Medicare Advantage plans, pricing and availability vary by county.

Even if you don’t currently need prescription coverage, we recommend enrolling in a lower-cost option to avoid the Part D penalty. 

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed California Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in California

The government has three programs that can help California Medicare beneficiaries with low income and resources.

California Medicaid

Medicaid is a joint federal and state program. California’s Medicaid program is called Medi-Cal. Through Medi-Cal, those who are 65 or older, blind, and/or disabled can receive ABD Medicaid benefits. California Medicare beneficiaries may also be eligible for one of four Medicare Savings Programs. 

California Medicare Savings Programs

• Qualified Medicare Beneficiary (QMB) pays the Medicare Part B premium (and sometimes Part A premium). The QMB program also pays for Medicare copayments and deductibles. 

• Specified Low-Income Medicare Beneficiary (SLMB) pays for members’ Part B premiums. 

• Qualifying Individual (QI) pays for members’ Part B premiums. Qualifying Individuals cannot also receive Medi-Cal. 

• Qualified Disabled and Working Individuals (QDWI) pays the Medicare Part A premium for those who lost their free Medicare Part A due to employment

For more information about the eligibility requirements and application process for California Medicare Savings Programs click here.

Medicare Extra Help

Extra Help (also called the Part D Low-Income Subsidy, or LIS) helps those with limited incomes and resources pay their Part D costs.

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from California

• California pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed California Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.