California boasts over 39 million people, well over 200 sunny days a year, and a laid-back lifestyle. It’s a great place to live no matter what age you are.
However, if you’re approaching 65, you might be thinking about Medicare and how you can make this important benefit work for you. You might wonder who can apply for Medicare in California, or if you need to even bother — aren’t you enrolled automatically?
This guide can help you understand how Medicare in California works and how you can ensure that you end up with the plan that’s right for you. Let’s get started!
Medicare is a federal program designed to help people access health coverage when they are less likely to have it through an employer — for example, those who are retirement age or disabled.
Original Medicare and Medicare Advantage are the two main varieties of Medicare. Original Medicare is the standard plan, although it may not be appropriate for your requirements. Part A (hospital insurance) and Part B (medical insurance) are included in original Medicare, as well as optional extras such as Part D (prescription drug insurance).
Medicare Advantage, also known as Medicare Part C, is a complete replacement for Original Medicare that may include additional perks. Private health insurance firms in the state sell Advantage plans, so California's Advantage plans will be distinct from those available in another state.
To be eligible for Medicare in California, you’ll need to meet specific requirements. You need to be a U.S. citizen or permanent resident who has lived in the US for at least five years, and one of the following conditions must also apply:
Once you qualify, you’ll be given an initial enrollment period to select the plan that’s best for you. You can enroll directly in a plan or be automatically enrolled in the default option.
Keep in mind that the default options are Original Medicare Part A and Part B. If you want additional coverage options or an Advantage plan, you’ll need to take action during your initial enrollment period to select those plans. It’s best to compare a few choices before making a final decision.
Can you get Medicare for free? As we mentioned, Medicare coverage is divided into different parts. Medicare Part A (hospital insurance) is premium-free for most Americans, based on you or a spouse paying into the Medicare system through your work for a specific period of time.
Medicare Part B (medical insurance) and Part D (prescription drugs) each have a monthly premium. In addition, when you use any of your Medicare coverage, you’ll have an annual deductible and coinsurance to take care of, while Medicare pays the rest. Learn more about premiums, deductibles, and Medicare costs in this guide.
Medicare Advantage plans have a monthly premium as well, although it may be the same as if you had Medicare Part B, which means you’re not paying any extra. These plans also have deductibles and coinsurance or copayments.
Medicare Advantage plans are available in all states. These are offered by private insurance companies and have at least the same level of coverage as Original Medicare, although they often have additional benefits as well. There are more than 29 million people enrolled in Medicare Advantage in California.
The important thing to note before choosing an Advantage plan is the medical provider network. While Original Medicare has a national network of providers, Advantage plans tend to be focused on your local area. You’ll need to ensure that your preferred doctors and specialists are included, and keep in mind that you may not have access to non-emergency care when you’re traveling.
Because there are a variety of Advantage plans available in California, you’ll want to carefully compare your options before you make a final decision. You’ll need to do this during your initial enrollment period, and you can make changes to your plan during the annual enrollment period (AEP) each fall.
How much are Medicare services in California? It depends on which coverage applies to your Medicare services.
For Original Medicare, you’ll generally pay no premium for Part A and $170.10 for Part B each month in 2022. Part D will have its own monthly premium based on the plan you choose.
If you choose a Medicare Advantage plan, you’ll pay the premium for that plan instead of A, B, and D. Often, an Advantage plan will charge the same as Medicare Part B.
Once you start using your coverage, you’ll have an annual deductible you cover first, and then Medicare coverage kicks in. After that, you’ll pay your coinsurance or copayment, and Medicare will cover the rest.
For example, for doctor’s visits, you use Medicare Part B, which has a deductible of $233 in 2022. Then you pay a coinsurance of 20% of the Medicare-approved cost, and Medicare pays the remaining 80%.
For a hospital stay, you use Medicare Part A, which has a deductible of $1,556. Then you have a $0 coinsurance for the first 60 days, and specific coinsurance amounts for days 61-90.
A Medicare Advantage plan will have its own deductible, coinsurance, and copay amounts. Contact the insurance company to get the details for your plan.
If you struggle to pay your Medicare premiums in California, there are Medicare Savings Programs (MSPs) available for those who have lower income and assets.
The most comprehensive plan is known as the Qualified Medicare Beneficiary program (QMB), and it takes care of your Advantage plan or Part A and Part B premiums, deductibles, and coinsurance payments. However, it also has the most restrictive requirements.
On the other end, the Qualified Individual (QI) program has looser requirements but only pays your Medicare Part B premiums.
If you have lower income and assets and have Original Medicare, you can also look into whether you qualify for Extra Help with Part D (prescription drugs).
Medicare Advantage plans can vary widely in cost and benefits, which is why it’s so important to compare coverage options before you commit to a plan.
Many plans will not have a higher monthly premium than you would normally pay for Medicare Part B. However, others will charge that amount plus an additional premium. If you see a Medicare Advantage plan advertising a $0 cost, they are referring to $0 above the Part B premium.
Each plan will have its own annual deductible and copayment or coinsurance amounts. You can get the latest information on cost changes to Medicare in 2022 in this guide. Be sure that those fees make sense, especially for the medical care you’re most likely to need. You’ll also need to make sure that the doctors you prefer are part of the provider network since there’s likely to be no non-emergency care outside the network.
An Advantage plan will have at least as many benefits as Original Medicare, but most offer additional benefits as well, such as vision or dental coverage. By comparing the costs and the benefits, you can choose the plan that’s best for you.
This guide answered many of the questions we’ve heard about Medicare in California, but don’t let that stop you from reaching out with your own specific concerns. We want to help you understand your Medicare benefits and compare Medicare quotes so you have the coverage you need. For more information, contact us today!
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