Medicare Advantage Plans in California

Medicare Advantage plans are private health insurance products. Medicare Advantage plans offer the essential Part A and Part B services under Original Medicare, as well as some expanded coverage that can include Part D, dental, vision and hearing coverage.

In California, there are more than 400 Medicare Advantage plans available in 2022. These plans fall under several types, including Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs) and Private Fee-for-Service plans (PFFSs).

Medicare Advantage is available to anyone who qualifies for Original Medicare and must cover at least what Original Medicare covers. You must be enrolled in both Parts A and B of Original Medicare if you want to switch to Medicare Advantage.

While there are hundreds of different Medicare Advantage plans available in California, not every plan is available in every part of the state. Availability depends on the insurance company offering the plan and where you live.

Everyone who has Medicare Parts A and B has the same coverage and can see any provider nationwide who accepts assignment from the Medicare program. Part A absorbs much of the cost of inpatient hospital stays and does so without the requirement of a monthly premium A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. if you’ve paid Medicare taxes through an employer for at least 10 years. Part B covers 80% of most medical needs outside of a hospital setting and generally requires a monthly premium.

If you have both Parts A and B, you can replace Original Medicare with Medicare Advantage, which offers at least the same coverage as Parts A and B. Some Medicare Advantage plans offer coverage options that Original Medicare doesn’t, among them transportation, meals and an allowance for over-the-counter supplies. You usually must see providers within a specific network to maximize savings.

California generally follows the federal requirements for Medicare Advantage plans but does have special considerations for Medigap plans. Medigap plans are offered by private insurance companies to help control costs for those on Original Medicare; you can’t have a Medigap plan if you switch to Medicare Advantage, but all Medicare Advantage plans provide the protection of an annual out-of-pocket maximum The maximum amount of money an individual will pay towards out of pocket expenses like deductibles, copayments, and coinsurance. .

The cost of Medicare Advantage plans in California will vary based on where you live and what coverage you want to have included in your plan. A GoHealth licensed insurance agent can help you find the right plan for your needs.

The average cost of a Medicare Advantage plan in California is $18.12 per month in 2022. Some people may also qualify for a no-cost premium; in California, 95% of people with Medicare have access to at least one of these plans based on their zip code, but actual eligibility must be determined.

To be eligible for Medicare Advantage in California, you first must be enrolled in both Parts A and B.

If you are a U.S. citizen age 65 or older, you qualify for Medicare (and some people, under special circumstances, are eligible before age 65). If you are set to be eligible at age 65, you can sign up for Medicare in the three months before or after the month you turn 65. You are automatically enrolled if you’ve been receiving Social Security benefits for at least four months prior to turning 65.

You can switch to Medicare Advantage during your Initial Enrollment Period (IEP) that surrounds your 65th birthday if you enroll in both Parts A and B first. If you don’t switch to Medicare Advantage right away, the most common period for you to switch in the future is the Annual Enrollment Period from Oct. 15 to Dec. 7 each year.

Most Medicare Advantage plans in California include prescription drug coverage.

Whether or not you choose a Medicare Advantage plan that includes prescription drug coverage is up to you. But both with Original Medicare and Medicare Advantage, you could face a late enrollment penalty if you don’t add Part D drug coverage when first eligible.

Without a Part D plan added to your Medicare Advantage plan, you should expect to pay the entire cost of your outpatient prescription medications. You may add Part D coverage during special enrollment periods. If you neglected to enroll in Part D at the same time as Medicare, a penalty may be added to your Part D premium for the rest of your life.