Medicare Supplement Plans in California

Summary: Medicare Supplement plans in California offer benefits that help cover the costs after Original Medicare pays its part. There are several plans and carriers available. However, it is essential to compare plans to find the right option for you.Estimated Read Time: 10 min

Beneficiaries enrolling in Medicare Supplement plans in California get special privileges not available in other states. Below, we discuss how Medigap is different in California.

Best Medicare Supplemental Insurance California in 2023

Like most other states, California offers ten lettered Medicare Supplement (Medigap) plans and two high-deductible options to those on Medicare. The most popular California Medicare Supplement plans are Medigap Plan F, Plan G, and Plan N.

These plans offer varying levels of coverage for when Original Medicare’s benefits end. Original Medicare is Medicare Part A and Part B, which you receive through the federal government.

However, Medicare Part A and Part B only cover 80% of your Medicare-approved inpatient and outpatient costs, respectively. For a monthly premium, a Medigap California policy fills your coverage gap, bringing you to 100%.

Determining the best Medicare Supplement plan in California is not easy. The best plan for one person may not be the best for another. Health and budget needs vary throughout the population.

One of California’s most popular Medicare Supplement plans is Medicare Supplement Plan F. Medigap Plan F coverage includes the Medicare Part A and Part B deductibles, copayments, coinsurance, foreign travel emergency coverage, skilled nursing care, and any excess charges. A high-deductible version of this plan allows you to keep the same benefits at a much lower cost.

Medicare Plan F California

Medicare Supplement Plan F provides the most comprehensive coverage of all Medigap plans available in California. It covers all the gaps in Original Medicare, including Part A and Part B deductibles, copayments, and coinsurance, as well as excess charges for doctors who don’t accept Medicare’s approved amount. Medigap Plan F in California also covers foreign travel emergency medical care up to your plan’s limits.

It’s important to note that as of January 1, 2020, Plan F is no longer available to new Medicare beneficiaries. However, if you were eligible for Medicare before January 1, 2020, or have an existing Plan F policy, you can keep your coverage. You can also still purchase Plan F if you were eligible for Medicare before January 1, 2020, but didn’t enroll in a Medigap plan at that time.

Medicare Plan G California

Medicare Supplement Plan G in California provides comprehensive coverage for Medicare beneficiaries. Like Plan F, Plan G covers most of the gaps in Original Medicare, but it doesn’t cover the Medicare Part B deductible.

Plan G benefits in California include:

• Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
• Medicare Part B coinsurance or copayments
• Blood (first 3 pints per year).
• Part A hospice care coinsurance or copayment.
• Skilled nursing facility care coinsurance.
• Foreign travel emergency care (up to plan limits).

Plan G is becoming a popular alternative to Plan F, as it offers almost the same comprehensive coverage but with a lower premium. Because Plan G doesn’t cover the Medicare Part B deductible, you are required to pay that amount out-of-pocket each year before your benefits kick in. However, the savings on the monthly premium may outweigh the cost of the deductible.

It’s important to note that Plan G premiums in California can vary. Be sure to compare plans from different insurers to find the one that offers the benefits you need at a price you can afford.

Medicare Plan N California

Medicare Supplement Plan N in California provides coverage for some of the gaps in Original Medicare, but not as much as Plan F or Plan G.

Plan N covers the following benefits:

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayment, except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission.
• Part A hospice care coinsurance or copayment
• Skilled Nursing Facility (SNF) coinsurance
• Foreign travel emergency medical care up to your plan’s limits.

It’s important to note that Plan N has cost-sharing features, which means that you’ll be responsible for paying some out-of-pocket costs, such as copays, deductibles, and excess charges.

For example, you’ll need to pay a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission. You’ll also be responsible for paying the Medicare Part B deductible.

Additionally, if your physician does not accept Medicare assignment, you may be subject to paying excess charges. This is a charge of up to 15% on top of the Medicare-approved cost for a service. Although the charges are rare, it is essential to speak with your doctor before receiving services.

Medicare Supplement Plan N typically has lower monthly premiums compared to Plan F and Plan G in California, making it a good option for those looking to save on their monthly costs. However, you’ll need to weigh the cost savings against the out-of-pocket costs associated with the plan.

As with all Medigap policies, it’s important to compare the benefits and costs of Plan N with other available plans to determine which plan is the best fit for your healthcare needs and budget.

Who Qualifies for Medicare in California?

In California, like the rest of the United States, Medicare provides coverage for people who are 65 or older and those under 65 who have certain disabilities or medical conditions.

Here are some of the eligibility criteria for Medicare in California:

• You must be 65 or older: If you’re turning 65 soon, you can enroll in Medicare during your initial enrollment period, which starts three months before your 65th birthday and lasts for seven months.
• You must have a qualifying disability: If you’re under 65, you may be eligible for Medicare if you have a qualifying disability and have received Social Security Disability Insurance (SSDI) for at least 24 months.
• You must have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS): If you have permanent kidney failure that requires dialysis or a kidney transplant, or have been diagnosed with ALS, you may be eligible for Medicare regardless of your age.
• You must be a U.S. citizen or permanent resident: To be eligible for Medicare, you must be a U.S. citizen or permanent resident who has lived in the United States for at least five years.

Once you’re eligible for Medicare, you can enroll in Original Medicare (Part A and Part B), which provides coverage for hospital stays, doctor visits, and other medical services. You can also choose to enroll in a Medicare Advantage plan or a Medicare Supplement plan to get additional coverage. Remember, you must choose to enroll in a Medigap plan or Medicare Advantage as you cannot be enrolled in both plan types at the same time.

Cost of Medicare Supplement Plans in California

Each person’s Medicare Supplement premium is unique to them and depends on several factors. In California, plan letter, carrier, age, and tobacco use status can all work together to determine your premium price. Thus, it is not possible to receive an accurate premium quote without speaking with a licensed agent.

Below, we provide sample Medigap premium rates for male and female beneficiaries, ages 65 and 75 in a California ZIP Code. None of the sample rates are for tobacco users.

* If on Original Medicare before 01/01/2020

Medicare Supplement carriers in California use the issue age or attained age Medigap pricing method to determine monthly premium rates. As you can see above, it often behooves you to enroll in Medigap when you are younger.

California Medigap Rating Method

In California, there are three rating methods used to determine the premiums for Medigap policies. These rating methods are:

• Community-rated: Under this method, everyone who purchases the Medigap policy in the same geographic area is charged the same premium, regardless of their age or health status.
• Issue-age-rated: This rating method takes into account the age of the policyholder when they first buy the Medigap policy. The premium is lower for younger policyholders, and it remains the same for the duration of the policy.
• Attained-age-rated: This rating method takes into account the policyholder’s age at the time of purchase and increases the premium as the policyholder gets older. Premiums may also increase due to inflation and other factors.

It’s important to understand that Medigap policies are standardized in California, meaning that the benefits are the same across all policies with the same letter designation (e.g., Plan F). However, the premiums can vary depending on the rating method used by the insurer. It’s essential to compare Medigap policies from different insurers to find the one that offers the coverage you need at a price you can afford.

California Medicare Supplement Carriers

Most major Medicare Supplement insurance carriers offer plans in California. Among the most prominent carriers in the state are:

• Mutual of Omaha
• UnitedHealthcare
• Cigna
• Blue Cross Blue Shield
• Aetna

Each carrier offers the same benefits among Medicare Supplement plans. This is because, in California, the state follows national Medigap benefit guidelines. However, certain carriers may offer perks to their members or have higher satisfaction ratings. So, you’ll want to take this into account when choosing a Medigap carrier in California.

Medigap in California Under Age 65

Not all states offer Medigap plans to those under 65 on disability. Fortunately, for those living in California, there are some plans available to you.

The downside to Medigap under 65 is the cost. Carriers tend to charge higher premiums to those eligible for Medicare due to their Social Security Disability (SSDI) benefits. A Medicare Advantage plan (Medicare Part C) could be an alternative if Medigap premiums exceed your budget.

When to Enroll in Medicare Supplement Plans in California

If you enroll in Medicare during your Initial Enrollment Period at age 65, the first time you can enroll in a Medicare Supplement plan is during your Medicare Supplement Open Enrollment Period. For many in California, this is the only opportunity to enroll in a Medigap plan without underwriting health questions.

If you received Medicare due to a disability before age 65, you get two Medicare Supplement Open Enrollment Periods. The first comes when you initially enroll in Medicare, and the second occurs when you turn 65. This ensures you get the opportunity to enroll in any Medicare Supplement plan, as not every option is available (or affordable) for those under age 65.

Suppose you delay enrolling in a Medicare Supplement plan due to creditable coverage. In this case, you will get a guaranteed issue period allowing you to enroll in a Medicare Supplement plan without underwriting health questions.

California Medigap Birthday Rule

California Medigap beneficiaries get a unique enrollment opportunity each year. The California birthday rule is excellent for CA residents because it grants an annual chance to enroll in a Medigap plan without the need to answer health questions.

This rule gives you 91 days surrounding your birthday to enroll in a Medicare Supplement plan. The window begins 30 days before your birthday and ends 60 days after your birthday. During this time, carriers cannot deny you coverage based on pre-existing health conditions.

California Medigap Birthday Rule Requirements

The California birthday rule only applies if you already have a Medicare Supplement plan in California. When using the rule, you can change your Medigap plan to one of equal or lesser benefits.

However, you may not change to a plan with more benefits than your current plan. This means you can go from a Medigap Plan G to Plan N with the same carrier, or from a Plan N with one carrier to Plan N with another at a lower rate. However, you cannot switch from a Medigap Plan G to a Plan F or from Plan N to Plan G.

Remember, this rule only applies to those already on a Medicare Supplement plan. It does not apply to beneficiaries with Medicare Advantage plans who wish to switch to a Medicare Supplement.

Also, you can still apply for a Medicare Supplement plan at any time of the year; you do not need an enrollment period. However, you must undergo medical underwriting during the application process. Thus, the carrier may deny you coverage because you are not guaranteed the policy.

Additional Medicare Coverage Options in California

Medicare Supplement plans are not the only coverage you will need when on Medicare in California. In addition to your Medigap plan, reviewing prescription drugs and ancillary coverage is essential to ensure you will be meeting all your needs.

Medicare Part D plans help cover the cost of prescription drugs. Alongside Medicare Part D, dental, vision, hearing, and critical illness policies are available to round out your Original Medicare and Medigap coverage in California.

Additionally, Medicare Advantage plans are an option for those in California who do not wish to enroll in a Medicare Supplement plan. Through private insurance companies, Medicare Advantage plans combine inpatient and outpatient benefits with additional coverage for a wide array of benefits, depending on your plan. The downside is their higher out-of-pocket costs and network restrictions.