California Medicare is unique because it has a few rules that only apply to California residents. Below we’ll discuss how California is different when it comes to Medicare, as well as inform you of any changes for 2021.
What is the California Medigap Birthday Rule?
Medigap in California has a unique birthday rule. The birthday rule is excellent for residents 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 91 days to enroll in a plan. They are allowing you to change your policy 30 days before your birthday and up to 60 days after your birthday.
When Does the Medigap Birthday Rule Apply in California?
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. 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.
When to Enroll in Medicare in California
The first time you can enroll in Medicare is your Initial Enrollment Period. 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.
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 may have to answer health questions.
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.
Plan G is almost as well-liked as Plan F. On many occasions, we’ve found that Plan G 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. 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.
Tobacco Rate Guidelines
If you’re a smoker, 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. If you lose Medi-Cal coverage, you’ll want to look into Mutual of Omaha Medigap plans, as well as United American and United Healthcare. These carriers offer plans with guaranteed issue when someone loses their Medi-Cal coverage.
Medigap in California if You’re Under 65
Not all states offer Medigap plans to those under 65. Fortunately for those living in California, there are some plans available to you.
The downside to these plans when you’re under 65 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.
Medicare Advantage Plans in California
Supplements provide the most comprehensive coverage but may not be affordable for everyone. 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.
The below Medicare Advantage plans are rated 4.5 out of 5 stars in California:
- SCAN Classic HMO
- Alignment Health Plan Platinum (HMO)
- Aetna Medicare Choice Plan (PPO)
Part D in California
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.
How to Apply for Medicare in California
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.