California Medicare Supplement Plans (Medigap)
California Medicare Supplement plans are private insurance policies that work alongside Original Medicare to cover things that Medicare does not. This includes out of pocket expenses like copays, deductibles and coinsurance.
Medicare Supplement plans are also called “Medigap” plans. Your California Medicare and Medicare Supplement options are broken down into parts and plans.
California Medicare Benefits Explained
- Part A covers hospitalization and inpatient procedures.
- Part B covers other medical expenses like doctor visits and outpatient procedures. Parts A and B together are often called “Original Medicare.”
- Part C, or “Medicare Advantage” is private health coverage that replaces Original Medicare Parts A and B. It may also offer prescription drug insurance or other benefits. Unlike Original Medicare, Part C plans usually operate with a network of healthcare providers, limiting your choices.
- Part D is a standalone Medicare prescription drug plan. Because parts A and B do not cover prescriptions, you must buy a Part D plan if you want coverage for medications.
In addition, Original Medicare beneficiaries are eligible to buy a California Medicare Supplement plan. It covers many of the healthcare costs that Medicare doesn’t pay. For most people, the most comprehensive coverage available is Original Medicare, plus a Part D prescription plan and a Medicare Supplement plan.
What Benefits does Medicare Include in California?
If you are hospitalized, Medicare Part A will pay for the first 60 days of a semi-private room. After that, you are required to share the cost. Part A will also pay for a limited amount of time in a skilled nursing facility after a hospital stay.
Medicare Part B pays 80 percent of your medical costs, including doctor bills, tests, emergency room visits and outpatient surgery. The other 20 percent is your responsibility.
Requirements for Medicare Supplement Plans in California
You are eligible for Medicare Supplement plans in California if you are at least age 65 and enrolled in Medicare Part B.
- If you are already receiving Social Security benefits, you will be automatically enrolled in Part B in the month you turn 65.
- Otherwise, you are eligible to enroll in Part B during an “initial enrollment period,” or IEP, that begins three months before your 65th birthday month and ends three months after the month you turn 65. If enroll after your IEP has ended, you will pay a late enrollment penalty every month for the rest of your life.
- You can, however, wait to enroll in Part B without a penalty if you have other health insurance through an employer or union. But if that coverage ends, you must enroll promptly to avoid the penalty.
If you receive Social Security Disability benefits or certain Railroad Retirement Benefits for 24 months, you automatically qualify for Medicare Parts A and B. Medicare Supplement plans A, B and F are available for Medicare recipients on disability in California. However, unfortunately not for recipients who have end-stage renal disease.
How to Sign Up for California Medicare Supplement Plans
The best time to sign up for a Medicare Supplement plan is the six-month open enrollment period. It begins on the first day of the month you are BOTH 65 or older AND enrolled in Medicare Part B. So if you turn 65 and are enrolled in Part B in March, your open enrollment period is from March 1st through August 31st.
If you buy Medigap coverage during your open enrollment period or when you have guaranteed issue rights, the insurance company must issue you a policy and cannot charge you more money based on your health. In addition, California has a unique “birthday rule”. This rule allows you to change your Medigap policy within 30 days of your birthday. Only as long as you switch to a plan with the same or fewer benefits.
You can still enroll in a Medicare Supplement plan outside of these time periods. However, it may be more difficult and expensive. Your policy will be medically underwritten. This means the insurance company does not have to approve you. They may charge you a higher premium if you have preexisting health conditions.
California Medicare Supplement Plans Costs
You’ll pay a monthly premium for supplemental Medicare coverage. The premiums are set by individual insurance companies based on a variety of factors, including your age, sex and where you live. Insurance companies do not all charge the same rates. A policy in San Francisco may not cost the same amount as a policy in San Jose.
In addition, insurance companies use three different pricing methods for Medicare Supplement plans. Your overall costs will depend on whether your plan uses community rated, issue-age-related, or attained-age-rated pricing. You can learn more about these pricing methods here.
One of the most popular plans, Plan F, includes coverage for both your Medicare Part A & B deductible, copayments, coinsurance, foreign travel emergency coverage, skilled nursing care as well as coverage for any Medicare Part B Excess charges. There’s also a high deductible version that allows you to keep the same benefits at a much lower cost.
Plan N is another plan that’s considered one of the best Medicare Supplement Plans in California. It covers the same benefits as Plan F minus your Part B deductible and it won’t cover any excess charges. There’s also a small copay for some office visits and emergency room visits.
Plan G is almost as popular as Plan F. The only difference is that Plan G doesn’t cover your Part B deductible, but it will cover any Part B excess charges.
California Medicare Advantage Plans
Medicare Advantage plans do not work with Medigap plans in California. In fact, if you have an Advantage plan you cannot sign up for a Medigap plan. Medicare Advantage plans are considered “Medicare Replacement Plans” because they replace your Original Medicare Parts A & B. They also come with many restrictions such as in-network doctors. They may seem like a cheaper alternative to a Medicare Supplement plan, but in the end you’ll have higher out of pocket costs.
California Medicare Part D Prescription Drug Plans
Original Medicare and Medicare Supplement plans don’t cover prescription drugs. Beneficiaries are highly advised to purchase a Medicare Part D stand-alone drug plan to get coverage for your medications. The ideal combination would be Original Medicare + Medigap + Prescription Drug Plan. That can give you piece of mind knowing that all your medical costs will be covered.
If you wait to enroll once your eligible, you could face a Part D penalty. The penalty is based on the number of months you went without credible coverage. Make sure to get a plan as soon as you’re enrolled in Medicare.
How to Apply for Medigap & Medicare Options in California Online
You should’ve been automatically enrolled in Original Medicare. Once you know your Part B is in effect, or going to be, you can then apply for additional supplemental coverage such as Medigap & Part D. It’s important to speak to a licensed insurance agent to make sure you have a good understanding of all your different California Medicare Supplement Plans and Part D options. As well as any additional plans for dental, vision, hearing and cancer, heart attack and stroke coverage.
To apply or inquire about information on Medicare options, fill out our compare rates form online or call us at the number above. Our services are 100% free. We work with all the top carriers and can take the confusion out of Medicare for you. We’ll compare rates in your area and once you decide on a plan, we’ll help you enroll.
California Medicare FAQs:
What age does Medicare start in California?
Coverage starts at the age of 65, unless you’re on disability. You should receive your Medicare card in the mail a few months prior to your 65th birthday. Once you know your Part B is in effect, you can sign up for a supplemental plan.
How much is the Medicare Part B premium in San Diego California?
Medicare Part B premiums are the same in all states, as of 2018 it’s $183. If you enroll in a Plan C, F or High Deductible F, your Part B deductible will be covered.
How to apply for Medicare Part D in California?
First you need to compare rates with the top carriers that offer Medicare Part D drug plans. You can get started by completing our compare rates form, or call us directly now. Don’t wait to enroll, otherwise you may be charged a penalty for each month you went without coverage.
How to apply for Medicare in Los Angeles?
As stated above, you should be automatically enrolled in Original Medicare, if not contact your local centers for Medicare and Medicaid services office or visit Medicare.gov. Once enrolled, contact us to get started with enrolling in supplemental options.
How do I Apply for Blue Cross Medicare Supplement Plans in California?
Blue Cross does offer Medicare Supplement plans in California. To compare rates, fill out our rate form or give us a call. We just need to know some specific information to give you an accurate rate.