Medicare Supplement plans protect you from the many potential out of pocket costs for services that are not covered by standard Medicare alone.

California is unique because it has a few rules that only apply to California residents. We work hard at keeping beneficiaries informed on any state-specific guidelines and changes regarding Medicare.

Below, we’ll breakdown what’s essential to know in 2020 if you’re on Medicare in California.

The page has been updated for 2020

Medicare Enrollment Periods in California

The first time you can enroll in Medicare is your Initial Enrollment Period. Your Initial Enrollment Period is 7-months long, starting 3-months before your birthday.

During this time, you can enroll in Part A & Part B. As soon as you get Part B, you’ll want to enroll in a Medicare Supplement Plan. This is because once you have Part B, your Medicare Supplement Open Enrollment Period beings.

That way, you won’t have to worry about your health impacting your approval odds and can skip over the health questions during the application process.

If you didn’t enroll in Part B during your Initial Enrollment Period, your next opportunity to enroll is during the General Enrollment Period. If you enroll during this time-frame, you will have to answer health questions.

It’s important not to confuse the General Enrollment Period of the Annual Enrollment Period. The Annual Enrollment Period is only for those who already have Part A & Part B.

There are also many Special Enrollment Periods for those who’ve had a change in circumstance.

California Medigap Birthday Rule

Medigap in California has a unique birthday rule. The birthday rule is excellent for Medicare beneficiaries in California because it gives you a yearly chance to enroll in a Medigap plan without having to answer health questions.

This rule gives you an extra 61 days to enroll in a plan. They are allowing you to change your policy 30 days before your birthday and up to 30 days after your birthday.

The birthday rule only applies if you’re already enrolled in a Medigap Plan in California. It allows a beneficiary to either keep the same plan or choose one with fewer benefits.

We’ll use the name Rose to give an example of how the birthday rule works.

Let’s say Rose has a birthday coming up and has Plan G. She has the option to search for another Plan G with a different carrier to get a lower premium. Or, Rose can switch to a different plan with fewer benefits, like Plan N.

However, she cannot go from Plan G to Plan F since Plan F has more benefits than Plan G.

This rule only applies to Medicare Supplement Plans. It does not apply to Medicare Advantage Plans.

If you’re outside any enrollment period, you can still apply for a supplement plan at any time of the year. However, you’ll have to go through medical underwriting during the application process.

How Medicare Supplement Plans in California Work

Let’s continue using the name Rose as an example. Rose is enjoying a beautiful summer day in California hiking in Mount Whitney. On her way down, she trips and ends up breaking her hip. She calls for help, and they send an air ambulance to help.

The air ambulance brings her to the closest accessible hospital emergency room. Rose ends up needing x-rays, CT scans & MRIs. Since Rose has Part A, Medicare will cover most of the expenses.

However, she’s still left responsible for the Part A deductible. If Rose had a California Medigap plan, the Part A deductible would be mostly, if not entirely, covered.

Rose then has multiple follow up appointments with her primary physician. Her doctors’ visits are covered under Part B. There’s also a deductible, plus 20% coinsurance on all medical services.

If Rose had a first-dollar coverage plan, the Part B deductible would be billed to her Medigap carrier. All supplemental Medicare plans will cover the 20% coinsurance.

What are the Best Medicare Supplement Plans in California

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, and any excess charges. There’s also a high deductible version that allows you to keep the same benefits at a much lower cost.

It’s important to note that first-dollar coverage plans will be unavailable to new enrollees after 2019. First-dollar coverage plans include Plan F, Plan C, and High-Deductible Plan F. As long as you were eligible for Medicare before 2020, you can still enroll in these plans.

Plan G is almost as well-liked as Plan F. On many occasions, we’ve found that Medigap Plan G in California can save beneficiaries more money annually than Plan F. Make sure to compare the costs of these two plans before you enroll.

Plan N is another plan considered one of the best supplement options in California. Plan N covers the same benefits as Plan F, minus your Part B deductible. There’s a small copay for some office visits and emergency room visits.

Costs of Medicare Supplements in California

Let’s use Rose again to go over the costs of Medicare Supplements in California. Rose is just turning 65 this month and lives in Los Angeles.

Since she’s in her Initial Enrollment Period, she was able to enroll in Part A & B. She has her Part B effective date & is ready to compare the costs of Medigap Plans in Los Angeles.

Rose gives us a call so she can compare the top plans with every carrier side by side.

When comparing Plan F in her area, we find that the lowest monthly premium is just over $180. When comparing Plan G, we see the lowest monthly premium is around $150. The last plan she wants to compare is Plan N. We find Plan N costs, on average, about $125 a month.

The above is an excellent example of when Plan G is sometimes the better value when compared to Plan F. The only difference between both of these plans is the deductible that falls under Part B.

When you do the math, the $30 more Rose will spend on monthly premiums with Plan F ends up costing far more than the current Part B deductible. So for her situation, Plan G is the best plan.

Tobacco Rate Guidelines

If you’re a smoker in California, it’s essential to know some carriers do apply tobacco rates during Open Enrollment. For example, certain carriers do apply tobacco rates during Open Enrollment, but not all. Make sure to ask your agent which carriers do and don’t use tobacco rates if you smoke to make sure you get the lowest prices.

Household & Spousal Discounts

Some carriers offer household and spousal discounts in individual states. In California, you’ll find some carriers offer a 5% spousal discount, and others provide a 12% household discount.

California Guidelines for Voluntary Group Termination

The California Guidelines for Voluntary Group Terminations state as long as your employer-sponsored plan is primary to Medicare, you have Guaranteed Issue Rights when enrolling in a Medicare Supplement plan.

California Guaranteed Issue Plans for Loss of Medi-Cal Coverage

Not all carriers will give you Guaranteed Issue Rights when you lose Medi-Cal coverage. In California, if you lose Medi-Cal coverage, you’ll want to look into enrolling with Mutual of Omaha, United American, or United Healthcare since they offer plans with Guaranteed Issue in this situation.

Medigap in California if You’re Under 65

If you receive Social Security Disability benefits or Railroad Retirement Benefits for 24 months, you automatically qualify for Medicare. However, not all states offer Medigap Plans to those under 65. Fortunately for those living in California, there are some plans available to you.

The downfall with these plans when you’re under 65 is the costs. Carriers tend to charge an obscene amount in premiums to those who are disabled. A Plan G in Los Angeles, California, for those under 65 will cost around $300 per month.

If the premiums are too expensive, an alternative might be a Medicare Advantage plan.

California Medicare Advantage Plans

Supplements provide the most comprehensive coverage but may not be affordable for everyone. In 2019, 40% of enrollees chose a Medicare Advantage plan.

One of the downfalls of Advantage plans is that you must use their network of doctors and hospitals.

You’re also responsible for copays for many things, including doctor visits, diagnostic testing, hospital stays, etc.

Let’s go back to Rose for a minute. Rose has a primary physician that she has seen for many years.

If she had a Medicare Advantage plan, she would’ve had to switch to one of her in-network providers for all her follow up visits after breaking her hip.

It’s also important to know you can only enroll, as well as disenroll, in Medicare Advantage plans at specific times of the year. Once you join, you could find yourself stuck with it for a year.

For those who find themselves stuck, the Medicare Advantage Open Enrollment Period runs annually from January 1st – March 31st.

The premiums for Medicare Advantage Plans in California will be between zero to $40 per month.

For example, let us say Rose was unable to afford a Medigap Plan, so she opted to enroll in a Medicare Advantage Plan. If she could not afford any premium, she could go with a Humana Honor HMO plan. That has a zero dollar deductible. However, it also has a $6,700 maximum out of pocket cost and doesn’t cover prescriptions.

If she could swing around $15 a month in premiums, she could go with an Anthem MediBlue Extra HMO. This plan has a Maximum Out of Pocket cost of $900 and does cover prescriptions. Unfortunately, Rose will have to change doctors since the network is small, and her current doctor is not in it.

According to the Kaiser Family Foundation, only six states have over 41% of residents choosing to enroll in Medicare Advantage plans. California has just under that, showing 40% of Medicare-eligible residents enrolled in Advantage plans in 2019.

Part D

Original Medicare and Medicare Supplements don’t cover prescription drugs. Some Medicare Advantage plans do, but not all. It’s essential to enroll in a Part D plan once eligible for Medicare.

Ideally, at the same time, you enroll in Part B. If you wait to sign up when your first eligible, you could face a Part D penalty. The penalty goes by the number of months you went without creditable coverage.

If Rose went with a Medicare Supplement Plan, she would then pick up a Part D plan to cover her prescriptions. In California, the average premium for Part D is between $12-$75 a month, depending on the benefits.

If Rose wanted a lower deductible, she could go with a SilverScript Choice PDP plan that costs around $30 per month.

California Insurance Resources

The California Department of Insurance is an excellent resource to find information regarding your Medicare.

Another great resource is HICAP, which provides free counseling and community education for beneficiaries in California.

For Native Americans 65 and older residing in California, you may have both Native American Health Insurance and Medicare. Many Native Americans qualify for Medicaid and Medicare. You can easily apply for extra help online.

Common Questions Regarding Medicare in California

What does Medicare cover in California?

Part A covers your inpatient services, and Part B covers your outpatient services. There are out of pockets costs. However, a Medigap Plan will help cover most, if not all, of them.

How to apply for Medicare in California?

The best way to apply for Medicare in California is online through the Social Security Administration website. You can then apply for additional supplemental coverage once you know your Part B effective date.

Who is eligible for Medicare in California?

Anyone who is at least 65 years old or collecting Social Security Disability Benefits for 24 months if eligible for Medicare in California.

Next Step

As you can tell from reading above, It’s essential to speak to a licensed insurance agent to make sure you have a good understanding of all your different Medicare options.

To apply or inquire about information on all your Medicare options, fill out our compare rates form or call us at the number above. Our services are 100% free.

We work with all the top carriers and can provide you with a nonbiased opinion on what your best options are.

Plus, if you enroll in a plan through us, you’ll have unlimited support from our Client Care Team. They will assist you in claims, as well as any other issues that may come up with your Medicare plan.