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Medicare in California

October 6, 2016

What choices may be available to Medicare beneficiaries in California that work alongside the federal government’s Medicare, Part A and Part B? Medicare Advantage (Medicare Part C) offers an alternative way to receive your Medicare Part A and Part B benefits, with possible additional benefits, and most Medicare Advantage plans include prescription drug coverage.

Or, if you decide to remain with Medicare Part A and Part B, you may consider a stand-alone Medicare Prescription Drug Plan. Also, Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B. Available plans vary depending on where you live.

Medicare Part A and Part B for California beneficiaries

Medicare Part A and Part B is the health insurance program created and administered by the federal government. It’s primarily for U.S. citizens and legal residents ages 65 and older, although people under the age of 65 with qualifying disabilities may also receive these benefits. Medicare Part A provides inpatient hospital care, and Medicare Part B covers doctor services, preventive exams, and durable medical equipment. Prescription drug coverage generally isn’t covered by Medicare Part A and Part B.

Medicare Part A and Part B is available to eligible beneficiaries in every state in the U.S., including California. It’s possible for beneficiaries to be automatically enrolled at age 65, provided they are receiving retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). Those who receive SSA disability benefits, or certain RRB disability benefits, for 24 consecutive months can join Medicare before age 65.

If you aren’t automatically enrolled, there are several ways to sign up for Medicare.

  • Apply in person at your local SSA office.
  • Register online.
  • Enroll by phone:
    • Call Social Security at 1-800-772-1213 (TTY users call 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
    • If you worked for a railroad, call the RRB at 1-877-772-5772 (TTY users call 1-312-751-4701), from 9AM to 3:30PM.

You should get your Medicare card in the mail about three months before coverage is scheduled to begin.

If you’re not automatically enrolled in Medicare Part A and Part B, and you miss your Initial Enrollment Period (the seven-month period around the time of your 65th birthday), you can enroll during the annual General Enrollment Period (January 1 to March 31). Medicare

may charge you a late enrollment penalty if you didn’t sign up when you were first eligible. 

Medicare plan options in California

Medicare plan options are available in California. These plan types are described in greater detail below, although pricing and availability may vary depending on your location.

It’s usually best to join these plans during your Initial Enrollment Period (described above). If you don’t join at that time, you can join, switch, or drop a Medicare Advantage plan or Part D plans during the Annual Election Period, from October 15 to December 7.

Medicare Advantage plans in California

Medicare Part C, known more commonly as Medicare Advantage, is a program where private insurance companies contracted with Medicare offer an alternative way to receive your Medicare Part A and Part B benefits. When you join a Medicare Advantage plan, you remain enrolled in Part A and Part B (and must continue paying your Part B premium), but your coverage is delivered through your new plan. These plans are required to cover everything that Medicare Part A and Part B does (except for hospice care–this remains covered by Part A) but many include other benefits, like routine dental, vision and prescription drug coverage.

Medicare plans that include prescription drug coverage in California

Medicare Part D offers a stand-alone Medicare Part D Prescription Drug Plan (prescription drug coverage), which can work alongside your Medicare Part A and Part B coverage. Because most medications are not covered by Part A and Part B, you will need to enroll in a stand-alone Medicare Prescription Drug Plan to receive this benefit.

If you choose Medicare Part C, Medicare Advantage plans usually offer prescription drug coverage and are often referred to as Medicare Advantage Prescription Drug plans.

Every Medicare plan that includes prescription drug coverage uses a formulary, which is a list of medications covered by the plan. Please note that formularies can vary from one company to another, and may change at any time (the plan will notify you when necessary). You might want to compare all offerings in your area and make sure to choose a plan that covers your prescription drugs.

If you don’t sign up for prescription drug coverage when you’re first eligible for Medicare–whether through a stand-alone Medicare Prescription Drug Plan or an Medicare Advantage Prescription Drug plan–you could face a late enrollment penalty if you want drug coverage later on.

Note: You generally can’t add a stand-alone Medicare Prescription Drug Plan to a Medicare Advantage policy. If you want prescription drug coverage and Medicare Advantage, make sure you enroll in a Medicare Advantage Prescription Drug plan. 

Medicare Supplement (Medigap) plans in California 

If you decide to stay with Medicare Part A and Part B, another option you may have is to sign up for a Medicare Supplement (Medigap) plan (offered by private insurance companies) to help pay for Medicare Part A and Part B out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. In 47 states, Medigap plans offer the same standardized benefits for plans of the same letter type. Note that some companies may offer additional innovative benefits.

For Medicare Supplement plans, if you don’t sign up during your Initial Enrollment Period, there’s no guarantee a plan would accept you, and you might have to pay a higher premium.

California resources for Medicare beneficiaries

There’s a lot to learn about Medicare, but you don’t have to educate yourself on your own. Medicare.gov offers a list of available resources for every facet of health care. We have included the Medicare-specific ones below so that you can reach out to these sources with any questions you might have.

  • State Health Insurance Assistance Program (SHIP): In California this is also called the California Health Insurance Counseling and Advocacy Program (HICAP). Call the toll-free number, 1-800-434-0222, Monday through Friday 8AM to 5PM PT, or visit the website
  • National Institute on Aging Information Center: Call the toll-free number: 1-800-222-2225 (TTY users call 1-800-222-4225) Monday through Friday, 8:30AM to 5PM ET, or visit the website.

Learn more about how Medicare plans work in California, including:

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.