Medicare in California

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.

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.

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 2022:

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.