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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.

Key Takeaways

  • Medicare in California is available to all legal U.S. residents aged 65 and older.

  • Original MedicareOriginal Medicare is a fee-for-service health insurance program available to 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 (Medicare Part C) 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 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.

What is Medicare Called in California?

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.

Who is Eligible for Medicare in California?

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.

How Does Medicare Work In California?

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.

Part A

  • Inpatient hospital stays
  • Skilled nursing and nursing home stays
  • Hospice care
  • Home health care

Part B

  • 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?

  • Apply online at the Social Security website [1]
  • Visit your nearest Social Security office in California [2]
  • Call 1-800-772-1213 (TTY: 1-800-325-0778)
  • Railroad retirees may need to enroll through the Railroad Retirement Board. Contact the RRB at 1-877-772-5772.

When are Enrollment Periods for Medicare in CA?

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.

How Much Does Medicare Cost In California?

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

Premium:

  • 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

Deductible:

  • $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

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in CA: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • 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, [3] 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:

  • Assess your needs
  • Medicare Star Ratings
  • Consider each plan’s pros and cons
  • Contact GoHealth: GoHealth can help with finding a Medicare plan in Michigan. Our licensed insurance agents will discuss your needs and shop for plans in your area that fit what you’re looking for.

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. [3] D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.

Medicare in California by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 5,608,325 people are enrolled in Medicare in California. The total number of beneficiaries enrolled in Medicare Advantage in California is 2,748,683. The previous year, 2,623,000 enrolled in Medicare Advantage. Medicare Advantage participation in California went from 47.88% to 49.01% year over year. If you’d like to dive deeper into how Medicare in California breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of California
5,608,325
Beneficiaries with Part A & Part B
2,748,683
Medicare Advantage Beneficiaries
49.01%
Medicare Advantage Participation Rate
53.97%
% Female
46.03%
% Male
1.03
Average HCC Score
$12,251.94
Actual Per Capita Costs
30.25%
% Eligible for Medicaid
28.63%
% of Beneficiaries with an Emergency Department Visit
18.58%
Hospital Readmission Rate
63.00%
% Non-Hispanic White
5.31%
% African American
17.08%
% Hispanic
14.61%
% Other/Unknown

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 Medicare Resources & Contacts

Beneficiaries spend an average of $12,251.94 each year on Medicare in California. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which California-based resources, like these, may be able to help:

California Department of Insurance

1-800-927-4357

http://www.insurance.ca.gov/

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)

1-800-541-5555

https://www.medi-cal.ca.gov/

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

1-916-654-3454

https://www.chhs.ca.gov/

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)

1-800-952-5626

https://www.calvet.ca.gov/

What Should I know about CalVet?

Connect with a host of veteran services, including information to get the most of your benefits

Nationwide Resources

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

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.