Medicare Supplement Plans in California
Thankfully, Medigap is just that, Medicare gap coverage. Surprisingly, annual Medicare Supplement premiums are mostly less than a single hospital stay deductible.
We’ll use the name Rose to give an example of how gap coverage protects your finances during retirement.
California Medicare Supplement Plans
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 $1,364 deductible. If Rose had a California Medigap plan, the Part A deductible would be mostly, if not completely, covered.
Rose then has multiple follow up appointments with her primary physician. Her doctors’ visits will be covered under Part B. There’s a $185 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.
California Medicare Parts A & B
If you are hospitalized, Part A will pay for the first 60 days of a semi-private room. After that, you’re 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.
California Medicare Part B pays 80% of your medical costs, including doctor bills, tests, emergency room visits, and outpatient surgery. The other 20% is your responsibility unless you have a Medigap policy.
Requirements for Medigap Plans in California
You are eligible for Medicare Supplement plans in California if you are at least age 65 and enrolled in Part B.
Eligibility for Medicare in California if You are Under 65 and Disabled
If you receive Social Security Disability benefits or certain Railroad Retirement Benefits for 24 months, you automatically qualify for Parts A and B. Plans A, B and F are available for recipients on disability in California.
The downfall with these plans when you’re on disability is the costs. Carriers tend to charge an obscene amount in premiums to those who are disabled.
If the premiums are too expensive, an alternative might be a Medicare Advantage plan
California Medigap Enrollment Period
If you buy Medigap coverage during your Open Enrollment Period, or when you have Guaranteed Issue (GI) rights, the insurance company must issue you a policy and cannot charge you more money based on your health.
Those new to Medicare are eligible for GI rights. Beneficiaries that recently lost Medicaid can enroll in a Medigap policy through Central States Indemnity, Mutal of Omaha, TransAmerica, United American, and United Healthcare.
Othertimes, beneficiaries may be eligible for a Special Enrollment Period that allows for a GI policy change. Working with an agent can save you time and money.
California Medigap Birthday Rule
The state of 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.
During this time, a carrier can’t deny your application. This rule ONLY applies to California Medicare Supplements.
This birthday rule provides beneficiaries an annual time to shop rates, regardless of your current health status.
You have the option to enroll in a less expensive plan each year around your birthday with guaranteed issue.
You can still enroll in a Medicare Supplement plan outside of these time periods. However, it may be more difficult and expensive.
The insurance company does not have to approve your application. They may charge you a higher premium if you have pre-existing 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. Your overall costs will depend on whether your plan uses community-rated, issue-age-related, or attained-age-rated pricing.
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 as well as coverage for any 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. There’s 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 this supplemental plan doesn’t cover your Part B deductible.
California Medicare Advantage Plans
Medicare Advantage plans do not work with Medigap plans. Medicare Advantage plans are considered “Medicare Replacement Plans” because they replace your Original Medicare. They also come with many restrictions such as in-network doctors.
Let’s go back to Rose for a minute. Rose has a primary physician that she has been seeing for many years. If she had a Medicare Advantage plan, she would’ve had to switch to one of her plans in-network providers for all her follow up visits.
California Medicare Part D
Original Medicare and Medicare Supplement plans don’t cover prescription drugs. 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 creditable coverage.
California Insurance Resources
The California Department of Insurance is a good resource to find information regarding your Medicare. Another great resource is HICAP, which provides free counseling and community education for beneficiaries in California. You can also find the Medicare & You guide on Medicare.gov.
How to Apply for Medigap in California
You can then apply for additional supplemental coverage once you know your Part B effective date.
It’s important 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 online 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 Medigap 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.