Introduction to Medicare Part C in California

The gaps in Traditional Medicare coverage might seem insignificant when you are new to Medicare, but not having those health benefits can become expensive over time if you aren’t protected. Medicare Advantage is a private form of health coverage which aims to protect seniors from those gaps. Essentially, it replaces your federal Medicare coverage with a private policy, plus additional coverage to avoid paying out of pocket for expensive coverage gaps.

Federal Regulations for Medicare Advantage

Medicare Advantage plans are required by federal law to offer you at least the same coverage as Traditional Medicare. Many plans contain more, such as extra benefits which cover gaps in Medicare, and/or dental. There are also very comprehensive plans which cover Medicare Part D (prescription drugs). These are referred to as MAPD plans.

Medicare Advantage Enrollment In California

Out of the total population of Medicare-eligible seniors in California, 38% of them are getting their benefits provided through a Medicare Advantage plan. Among these plans are different sub-categories, which the chart below details (as well as an approximate % of enrollees). The other 62% of California seniors might be signed up with an alternative, such as Medigap insurance.

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Do you smoke? Are you male, or female? Did you enroll in Medicare once you turned 65, or did you delay enrollment for some reason? All of these factors, and more, will determine your monthly premiums for a Medicare Advantage rate. The chart below displays estimated quotes for what seniors near you are paying:

Most Popular Medicare Advantage Plans in California

Medicare Advantage plans, like most private health insurance, will vary by location as well as by provider. They will additionally vary by provider network limitations. With an HMO plan, for example, you’ll be paying a more affordable rate, but have more restricted access to doctors and hospitals. PPOs are the opposite – you have a variety of choice, but a higher monthly premium.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Different Medicare Advantage plans come with different provider restrictions (restrictions on which doctors you are allowed to see, and which hospitals you are allowed to visit). Some networks, like HMOs, are highly restrictive whereas PPOs and PFFS plans give you more freedom. However, restrictions on these networks could change at any time, as well as the approved doctors and facilities you are allowed to use. You should have a game plan ready for if and when these restrictions change.

Doctor/Providers List

Drug, Vision and Dental Coverage

Sadly, Medicare Parts A and B do not offer coverage for dental, vision, or prescription drugs. While Medicare Part D is an option to help you with your expensive prescriptions, few other supplements offer affordable access to these ancillary benefits. But with a Medicare Advantage plan, you can get some or all of them bundled into the same policy, should you choose. But keep in mind that this will increase your rates.

Enrollment Options & Best Time To Enroll

Keep in mind that, while it is easy for some seniors to get covered with a Medicare Advantage policy, your provider may wish to give you a health screening or gather information about any pre-existing health conditions. You may or may not be denied coverage due to extreme health conditions such as End Stage Renal Disease (ESRD). If you contact a licensed insurance agent, they can help you determine what your options are based on your circumstances. For more questions about enrollment, please visit our Medicare Advantage Enrollment Page.

  • Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.

What Medicare Advantage Plan Is Best For Me?

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