Medicare Supplement Plans in California

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.

Medigap Plan Availability in California

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 policy fills your coverage gap, bringing you to 100%.

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, and Aetna.

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Best Medicare Supplement Plans in California

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.

Medigap Plan G is almost as well-liked as Medicare Supplement Plan F. On many occasions, though, we find that Medigap Plan G can save beneficiaries more annually than Medigap Plan F, even though with the latter, the beneficiary is responsible for the Medicare Part B deductible.

Medicare Supplement Plan G comes with lower premium rates. Additionally, Medigap Plan F is only available to those who became eligible for Medicare before 2020.

If you qualify for both options, make sure to compare the costs of these two plans before you enroll. There are also high-deductible versions of both options. Medicare Supplement High Deductible Plan F and High-Deductible Plan G are attractive options for those looking for a lower monthly premium. For one of these plans to work for you, you must be willing to take on a higher deductible in exchange for the lower premium.

Medicare Supplement Plan N rounds out the list of what are considered the best Medicare Supplement plans in California. Medigap Plan N covers many of the same benefits as Plan G. However, when you enroll in Medicare Supplement Plan N, there is a small copay for some office and emergency room visits.

Additionally, you could be responsible for excess charges when seeing doctors who do not accept Medicare assignment, as California allows excess charges. Excess charges are up to a 15% additional cost on top of the Medicare-approved amount for a service.

However, if you receive care in one of the few states that do not allow excess charges, you will not need to pay them. The fact that you live in California would be irrelevant, as it is similar to paying road tolls in other states.

Also, some carriers offer household and spousal discounts on Medigap plans in California. Certain companies offer a spousal discount, and others provide a household discount, depending on your area. These discounts can range anywhere from 5%-20%. It is wise to work with a knowledgeable agent who will find the best plan for you.

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.

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 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.

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.

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 drug 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 allow you to combine additional benefits with your Original Medicare for a wide array of coverage, depending on your plan. The downside is their higher out-of-pocket costs and network restrictions.

How to Apply for Medicare Supplement Plans in California

When shopping around for Medicare Supplement plans in California, you must speak with a licensed insurance agent to ensure you understand all your Medicare options.

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

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