Medicare in California - Plan Options
The federal government offers Medicare, a medical insurance program, for eligible individuals in California who are either 65 years or older or have a qualifying disability. More than 3.5 million individuals in California are enrolled in the Original Medicare program.
Medicare Plans in California
Multiple Medicare plans are offered in California, and each plan provides varying levels of coverage based on your medical needs and lifestyle. If you suffer from multiple health conditions or a disability, Original Medicare may not cover all your expenses, resulting in higher out-of-pocket costs. For comprehensive care, Medicare Advantage could be a suitable alternative. However, if you are seeking maximum coverage, a Medigap plan is recommended as it can cover the gaps left uncovered by Medicare.
Here are the five types of Medicare plans in California:
Original Medicare (Parts A & B)
Original Medicare is the cornerstone of the Medicare program in California, encompassing both Part A (hospital insurance) and Part B (medical insurance). Part A is typically offered without a premium to individuals who have contributed to Medicare taxes for at least ten years. On the other hand, Part B entails a monthly premium based on income. While Original Medicare covers a wide range of healthcare services, it’s important to note that it doesn’t cover all expenses, such as prescription drugs.
Medicare Advantage (Part C)
In California, private insurers offer Medicare Advantage (MA) plans approved by Medicare. These plans provide all the benefits of Original Medicare, with the added advantage of extra benefits like a prescription drug, vision, dental, and hearing coverage. Compared to Original Medicare, MA plans may have lower out-of-pocket costs. Given California’s wide range of Medicare Advantage plans, it’s wise to explore different options and select the plan that best suits your needs.
Medicare Supplement Insurance (Medigap)
Private insurers provide Medigap plans in California to bridge the gaps in Original Medicare coverage, such as deductibles, co-payments, and coinsurances. These ten Medigap plans are standardized by the government and are labeled with letters A through N, with Medigap Plan G being the most popular choice. The benefits remain the same regardless of the insurance company offering the plan. Please note that Medigap policies have a monthly premium in addition to your Original Medicare premium.
Medicare Prescription Drug Plans (Part D)
Prescription drug coverage is not included in Original Medicare in California. However, you can obtain it through a separate Medicare prescription drug plan offered by private insurers approved by Medicare. Choosing a plan that covers the medications you need is crucial, as each plan has a formulary or a list of covered prescription drugs. It is worth noting that there may be formulary changes from year to year.
Special Needs Plans (SNPs)
In California, Special Needs Plans (SNPs) are Medicare Advantage plans designed for individuals with specific chronic conditions or those needing specialized care, such as those with Medicare and Medicaid coverage. Three SNPs are available: Chronic Condition SNPs, Dual Eligible SNPs, and Institutional SNPs. However, it is essential to note that not all SNPs are accessible in every region of California, and eligibility for SNP plans may vary for individuals.
Medicare Eligibility in California
In California, Medicare benefits are available to individuals who are 65 years old or older, those who are younger but have disabilities, and those who have been diagnosed with End-Stage Renal Disease (ESRD).
Medicare eligibility in California is based on national standards set by the Social Security Administration (SSA). You can qualify for Medicare if you are a U.S. citizen or permanent resident who has worked for ten or more years in jobs that require Medicare taxes and you are now 65 years old. But before applying for Medicare benefits, you must have lived in the U.S. for five years.
Individuals younger than 65 may be eligible if they have received Social Security disability benefits for at least 24 months or have ESRD. Individuals with ESRD must also meet residency requirements to be eligible.
In addition to meeting specific eligibility requirements, applicants must apply for Medicare coverage before their 65th birthday or within three months after their disability begins to avoid late enrollment penalties. Applicants can use the Social Security website or visit a local office for assistance and advice.
How Do I Apply for Medicare in California?
Applying for Medicare in California is an easy process. You can apply online or by phone.
If you apply online, you must visit the Social Security Administration website and complete an application. The website includes a helpful tutorial that walks you through the process step-by-step. Once your application has been submitted, completing the process typically takes less than 10 minutes.
If you prefer to apply over the phone, call 1-800-772-1213 (TTY users should call 1-800-325-0778).
As you can see, each plan type has unique features and benefits. Choosing the right Medicare plan in California can seem daunting initially, but don’t let that scare you off. Take some time to research, ask questions, and decide which plan best fits your specific healthcare needs and budget.
California Medicare Resources
If you live in California, learning about the available Medicare plans is important. You can access various resources that enhance the well-being of seniors and caregivers. Area Agencies on Aging (AAAs), public health agencies nearby, and nonprofit groups offer essential information and programs for seniors.