Medicare in California
Everything you need to know about Medicare in CA, from who’s eligible to how much it costs
Reviewed by: Brett Braithwaite, Licensed Insurance Agent. Written by: Aaron Garcia.
Medicare in California is available to all legal U.S. residents aged 65 and older.
Original MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). covers hospital and medical services with Parts A and B. Medicare AdvantageMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in California is an alternative that often includes other services and Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. prescription drug coverage.
The cost of Medicare plans in California depend on standardized costs and other factors, including your income.
As a good Californian, you know your way around the state. You can explain which highways and side roads will get someone across town, to the beach, or all the way up to Tahoe.
But finding the right Medicare plan in California can leave even the most seasoned Golden Staters feeling lost. Who’s eligible for Medicare in CA? What are the types of Medicare? Can you enroll in Medicare Advantage in California? To find your answers, let GoHealth point you in the right direction.
Medicare in California is simply called Medicare. It’s federally funded health insurance for legal U.S. residents aged 65 and older. If you have Original Medicare, you can use it anywhere in the country that accepts it.
Many people mistake Medi-Cal for the state’s Medicare program. Instead, Medi-Cal is California’s Medicaid system. Medicaid provides a variety of services for low-income children, adults and families.
Medicare plans in California are for legal U.S. residents aged 65 and older. You may also be eligible to start receiving Medicare in California if you’re younger than 65 and receive Social Security Disability Income (SSDI) or Railroad Retirement Board (RRB) benefits.
Amyotrophic Lateral Sclerosis (ALS)
If you have ALS, also known as Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits in California. Medicare in CA also may cover End Stage Renal Disease (ESRD) if you’re younger than 65.
The federal government partially funds Medicare in California through taxes. When researching Medicare plans in California, you’ll see it’s broken down into four parts. Knowing what they do and how they work together can help you choose a plan that works for you. Here are the four parts of Medicare in California, starting with Original Medicare and Medicare Advantage:
Original Medicare (Part A and Part B)
If you’re enrolled in Original Medicare in California, your coverage is made up of two main parts: Medicare Part A and Medicare Part B.
- Inpatient hospital stays
- Skilled nursing and nursing home stays
- Hospice care
- Home health care
- Medically necessary doctor care
- Preventive services
Medicare Advantage (Part C)
Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.
Medicare Part D (Prescription Drug Plan)
Medicare Prescription Drug Plan (Part D) provides prescription drug coverage as a stand-alone plan. Medicare Advantage in California often includes Part D coverage; if you’re on Original Medicare, you’ll need to add Part D separately.
Medicare Supplement (Medigap)
Also called Medicare Supplement Insurance, Medigap covers some of the services and out-of-pocket costs that Original Medicare doesn’t. There are many different Medigap policies to supplement Medicare plans in California.
How do I Enroll in Medicare in California?
Want to apply for a Medicare plan in California?
There are several Medicare enrollment periods in California to know about, and each can help with different needs. Here are the enrollment periods to circle on your calendar.
Are you getting ready to turn 65?
Initial Enrollment Period is your first chance to sign up for Medicare plans in California when you turn 65.
Already enrolled in Medicare in CA?
Medicare Part C & Part D Open Enrollment Period allows you to change from Medicare Advantage in California to Original Medicare (or vice versa). This enrollment period is annually Oct. 15 to Dec. 7.
Medicare General Enrollment Period is helpful if you miss your Initial Enrollment Period. Use the General Enrollment Period to enroll in Medicare in California. Held annually from Jan. 1 to Mar. 31.
Medicare Advantage Open Enrollment Period allows you to switch back to Original Medicare or change Part C plans each year from Jan. 1 to Mar. 31.
Medicare plans in California are based on a set of standard costs, but your payment depends on your policy and needs. Here are the standard costs for Original Medicare in 2021:
Medicare in CA: Part A
- Typically no-cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $259 a month
- You or your spouse worked fewer than 7.5 years: $471 a month
- $1,484 each plan period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare in CA: Part B
- $148.50 monthly and up (income-based)
- $203 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare in CA: Part D
- Income-based; varies by plan
- No more than $445 in 2021
Copayments & coinsurance:
- Plan- and drug-specific
Assistance Programs for Medicare in California
There are several resources for low-income residents looking for Medicare in California. Here are a few examples:
- Medicare Savings Program (MSP) can lower the out-of-pocket costs associated with your Part B coverage based on your income and resources. An MSP may pay a portion or all of your premium, coinsurance, deductible, and prescription drugs.
- Medicare Extra Help, also known as the Low Income Subsidy (LIS), can help pay for your Medicare Prescription Drug Plan Part D premium, deductible, coinsurance and copayments.
- California Programs for All-Inclusive Care for the Elderly (CalPACE) provides nursing home-level care to those who are still living at home. In California, you must be 55 and you must live within a PACE service area.
How Much Does Medicare Advantage Cost In California?
There is no standard cost for Medicare Advantage in California. In 2021, premiums for Medicare Advantage in California are expected to average $23 per month,  though your actual price will depend on the county you live in and what your plan covers. This amount is on top of the regular Medicare Part B premium you pay each month. Medicare Advantage typically includes your Part D coverage.
What is the Best Medicare Plan in California?
The answer here is completely personal because everyone’s healthcare needs are unique. In other words, a Medicare policy that’s great for a loved one may not be for you. Here are some tools to help you determine the Medicare plan in California that will fit your needs:
What Are the 4 Types of Medicare Advantage Plans?
There are four main kinds of Medicare Advantage in California:
- Health Maintenance Organization (HMO) Plans: plans that use a network of doctors, hospitals and other providers to treat an insurance company’s customers. With an HMO, you’ll have a primary care physician to maintain your care.
- Preferred Provider Organization (PPO) Plans: plans that allow you to see any doctor in your provider network without a referral from your primary care physician.
- Private Fee-for-Service (PFFS) Plans: these plans pay healthcare providers separately for each service.
- Special Needs Plans (SNPs): plans designed specifically for patients with specific conditions, diseases or health characteristics.  D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
California Department of Insurance
What Should I know about the California Department of Insurance?
File a complaint, ask questions and get needed info about your health insurance.
Medi-Cal (California Medicaid)
What Should I know about Medi-Cal?
State-backed health insurance for low-income adults, families and children
California Department of Health and Human Services
What Should I know about the California Department of Health and Human Services?
CDHHS provides access to California’s public health, aging and health care resources
California Department of Veterans Affairs (CalVet)
What Should I know about CalVet?
Connect with a host of veteran services, including information to get the most of your benefits
Speak with an insurance agent that is licensed in California about your Medicare questions.1-855-792-0088 TTY: 711
Monday - Friday, 8 AM - 9 PM CT
Medicare & Medicaid
If you have general questions about Medicare in CA, or need help with current Medicare benefits.1-800-MEDICARE (1-800-633-4227)
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET