Any California resident who is 65 years of age can enroll in one of the many Medicare plans in California. When you enroll, you’ll be signing up for both parts A and B. These first two parts of Traditional Medicare are designed to cover most of your health care needs, including hospital visits and outpatient care. Although Medicare aims to be comprehensive, it does not cover everything – and the things which it does not cover could end up costing you a lot of money.
Depending on your employment history, you could end up paying premiums for Part B only, or for both parts A and B. Unfortunately, Part B premiums are mandatory for every Medicare beneficiary. You could be excluded from paying premiums on Part A, but only if you have a 10 year employment history (a total of 40 quarters). If you have less than that, it is highly likely that you will be required to pay a premium for Part A as well.
When you first apply for Medicare, you will automatically be eligible for Medicare Part A benefits. These benefits include mostly hospital expenses, but could also provide financial assistance for things like hospice care and other, long term health assistance. Part B is optional, but can take a significant financial burden off of common health care expenses like doctor visits, outpatient rehabilitation, medical supplies, and more.
If you decide to go with a Medicare Part C plan, understand that you will essentially be signing up for private insurance from a private insurance company. You will deal with that company only, and your insurer will be the one responsible for getting compensated by the government. Medicare Advantage plans also require you to sign up for both part A and Part B benefits. When you purchase a Part C plan, Part B is no longer optional for you. Furthermore, if you want coverage for your prescription drugs, you are going to want to sign up for Medicare Part D. Like Medicare Part C, the caveat for Part D eligibility is that you must sign up for Parts A & B. If you only sign up for Part A, you cannot get prescription drug coverage.
Below are some specifics on what type of coverage Original Medicare provides:
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
California Medicare Insurance Programs
There are over 5 million Medicare beneficiaries located within the state of California. Of those 5,000,198 recipients, 38% are enrolled in a Medicare Advantage program (approximately 1.9 million members). Unfortunately, reporting laws in the state of California make it difficult to know for sure how many residents are enrolled in a Medigap policy, an employer benefit program, or whether they are relying on Traditional Medicare alone to cover their healthcare needs.
For the record, you can’t qualify for any form of Medicare supplement in California unless you are currently receiving Medicare benefits from the federal government. Click here for more information on federal Medicare benefits, or for the option to enroll online.
The Importance of Supplemental Medicare Coverage
Health care costs have been rising significantly in recent years. Although Medicare Parts A and B are intended to comprehensively cover your healthcare needs, there are holes in its coverage options which you could be required to pay for out-of-pocket. If this happens, you might be saddled with thousands of dollars in medical expenses. Below are some examples:
|Medicare Part A Costs||Medicare Part B Costs|
Unfortunately, the cost of quality healthcare in California is on the rise – and it doesn’t look like it will be going down anytime soon. Most people of retirement age and older will be living on a fixed income at some point in the near future, and these rising costs become more expensive and harder to deal with as you age. Supplemental plans help take the burden of those expenses off of you so that you can enjoy your golden years.
Supplemental health insurance is designed for those 65 and older who want to protect themselves from every angle when it comes to their medical coverage. For a little bit of extra money each month, you can protect yourself from some significant financial burdens when your health care expenses start to increase. The plans are easy to understand, and even though it is a private insurance policy, the company works on your behalf to settle costs with the government. This can protect you from the emotional hassle of getting your claims honored as well as the financial stress.
Medicare is fairly comprehensive, But it doesn’t cover everything. Medicare Part a can be especially porous when it comes to prolonged hospital visits and extensive treatment, such as blood transfusions. There are also some gaps in Part B which most senior citizens don’t know about. These can be surprising, as well as surprisingly expensive if you aren’t prepared for them.
You have several different choices when it comes to designing a Medicare health insurance plan that works best for you. Probably the biggest choice out of all of them is whether or not to go public, or private. The two private options are a Medicare Advantage plan (Medicare Part C) or a Medigap supplemental insurance policy. There are pros and cons to each one, so be sure to think carefully before you make a final decision.
Supplementing Your Medicare with a Medigap Policy
Unlike Medicare Advantage, a Medigap Policy will not replace your Medicare benefits. Medigap policies are a form of private insurance that works with the government to cover the “gaps” in Original Medicare. There are ten federally-approved plans. These plans are labeled alphabetically: A, B, C, D, F, G, K, L, M, and N. There used to be plans N, E, H, and I; however, those were phased out in 2010 due to the Medicare Modernization Act. All Medigap plans offer identical benefits from state-to-state. But prices and providers will vary by location.
This handy chart details what each Medigap plan covers:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$116||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$118||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$105||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$104||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$70||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$97||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$69||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$76||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$45||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$97||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Medicare Part C: Medicare Advantage
Medicare Part C, also known as Medicare Advantage, is a private variation of Original Medicare. It offers the same exact benefits that Traditional Medicare does (as required by law), but through a private insurance company. Sometimes, there may be additional coverage options in addition to what Traditional Medicare provides. But if you opt into a Medicare Advantage plan, you’ll essentially be opting out of getting your Medicare needs met by the government.
There are benefits and drawbacks to enrolling in Medicare Advantage. On the one hand, it isn’t uncommon for these plans to also offer benefits such as dental or prescription drug coverage – these extra benefits help sell policies and make money for private insurance companies. However, one of the most common complaints associated with Medicare Advantage is the restrictive medical networks. Whether or not your Medicare Advantage policy will require you to change doctors involves a number of variables.
Depending on where you live, California HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Orgnizations) can vary in price.
What is the Difference Between Medicare Supplement and Medicare Advantage in California?
There are, in fact, many differences between a Medicare Advantage and a Medicare Supplement Plan. Medicare supplements, also known as Medigap, work with the government to pay remaining costs after your claim has been settled with Medicare first. Your Medigap plan may even pay certain costs, like coinsurance and/or deductibles, for you. Unfortunately, things like prescription drugs and other products or services not covered by Medicare won’t be covered by your Medicare Supplement Plan, either. In such instances, you should seriously consider purchasing Part D coverage.
When you purchase a Medicare Supplement Plan, it will be issued by a private entity. No matter which state you live in, each plan will have a letter designation trauma such as “Medigap Plan F”. These plans are standardized across the board, so Medigap Plan F in Alabama will provide the same benefits as Medigap Plan F in Alaska or Texas. This applies to California residents, too. Private companies who sell Medigap Insurance are legally required to follow state and federal laws regarding your Medicare coverage.
Medicare Advantage, on the other hand, is very different from a Medicare supplement. They don’t simply supplement government health care with private coverage – they completely replace it. However, your Medicare Advantage plan is legally required to provide you with the same benefits as you would get from Medicare Parts A and B. Many Medicare Advantage providers like to offer additional benefits and services in order to attract more customers. But the networks of doctors and hospitals where you can get care can be extremely limited in some cases.
Furthermore, because Medicare Advantage plans are more susceptible to free market fluctuations in medical costs, it can be difficult to predict how much you will end up spending for your medical care. Yes, in some states, your Medicare Advantage plan could be potentially cheaper when it comes to things like insulin or co-pays for doctor visits. But in other areas, Medicare Advantage can be significantly more expensive than traditional Medicare.
Below, you can see a chart with traditional questions about Medicare supplements and Medicare Advantage plans. We have done our best to provide short, factual answers so that you can make the best decision for yourself. As soon as you are ready to compare policies and companies, click here for a free quote.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Medicare calculates average costs in your region and pays that money to the private company you choose to manage your Part C plan. Your provider may also ask you to pay a monthly premium.||Almost all of your medical expenses are covered by your monthly premiums.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||Under rare circumstances, you may have no premium at all because the government subsidy will cover your costs. But in some areas, it can be quite expensive.||Each plan will require a relatively affordable monthly premium.|
|What will the plan cover?||The most basic plans will cover the same benefits as Medicare Parts A and B. Some plans may offer additional benefits such as Vision or prescription drugs.||Comprehensive plans, such as Plan F, will take care of 100% of the gaps not covered by Medicare Parts A and B. Smaller plants won’t cover as much.|
|Is it easy to budget my health care expenses?||Like regular health insurance plans, the more often you need medical care, the more often you’ll be paying out-of-pocket expenses associated with your plan.||Most people only need to pay for the monthly premium and the occasional out-of-pocket cost for a Medigap supplement.|
|Is my plan guaranteed? Or can it be cancelled?||Your insurance provider has the option to review their services on an annual basis and choose whether or not to raise your premiums, cancel coverage, or offer you a better deal.||There are only two ways your Medicare Supplement Plan could be canceled: failure to pay premiums, or the company’s bankruptcy. Otherwise, you are guaranteed coverage.|
|Do I have to clear a pre-approval or pre-certification process?||Yes. This is especially true if you have particularly expensive health care needs.||As long as you qualify for Original Medicare, you will qualify for a Medigap supplement, no questions asked.|
|Am I limited to specific doctors or hospitals?||Almost always, yes. Your insurance provider will have a list of pre-approved doctors and hospitals that they expect you to use. But these may change at any time.||As long as your doctor or hospital accepts Medicare, you are free to get care there without financial repercussions.|
|What type of plan is best for me?||Medicare Advantage plans tend to work well for younger retirees with few medical conditions, limited incomes, and who live in high population areas.||Medigap plans work best for those living in low population areas, who stick to a budget, and who want the most comprehensive coverage available.|
Need More Information on Medicare Plans in California?
There are a number of variables which will determine whether or not you should supplement your Original Medicare coverage. This article alone can only cover the basics. To make the best possible decisions about your health care, use the contact information below to speak to your local Medicare experts.
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.