Medicare Supplement (or Medigap) plans in California are available through private insurance companies, and they’re designed to help cover expenses incurred under Original Medicare, Part A and Part B, including copayments, coinsurance, and deductibles, as well as other out-of-pocket costs. Keep in mind that if you have Medicare Part C, Medigap plans can’t be used to pay for out-of-pocket costs with your Medicare Advantage plan.
As a California beneficiary, you may have a number of Medigap plan options available to you, with plans varying depending on the zip code you live in.
How Medigap plans work in California
In California, you have access to the same 10 standardized Medigap plans available in 47 states – all but Massachusetts, Minnesota, and Wisconsin, which have different types of Medigap plans. Each Medigap plan is labeled with one of 10 letters (A, B, C, D, F, G, K, L, M, and N), and plans of the same letter offer the same benefits.
You’re eligible for Medigap insurance if you’re enrolled in Original Medicare, Part A and Part B. The best time to buy a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month period starts the first day a beneficiary is age 65 or older and is also enrolled in Medicare Part B. During this time, Medicare beneficiaries in California can sign up for any Medicare Supplement plan available in their area, offered by any insurance company, without being subject to medical underwriting or denied coverage for pre-existing conditions. These special Medigap protections are known as “guaranteed-issue rights” because insurance companies must issue you any plan offered in your service area during this period. Keep in mind that while you can’t be rejected for coverage altogether because of your medical status, the insurance company is allowed to make you wait up to six months before covering pre-existing conditions – even if you apply during your Medigap Open Enrollment Period. Outside of your one-time Medigap Open Enrollment Period, it’s generally harder to switch plans unless you have guaranteed-issue rights, and if you are able to find an insurance company that will sell you a policy, you may have to pay more for that coverage if you have health problems.
California is one of the few states that have state-specific guidelines to make it easier to switch Medicare Supplement plans outside of your Medigap Open Enrollment Period. Under the California “birthday rule,” a Medicare beneficiary who already has a Medicare Supplement plan can switch to a different Medicare Supplement plan for a period of 30 days following his or her birthday each year. During this time, Medicare beneficiaries in California are allowed to change Medigap plans with guaranteed issue as long as their new plan provides equal or lesser coverage than the Medicare Supplement plan that they’re currently enrolled in. This means that if you’re a California resident enrolled in Medicare Supplement Plan A, you wouldn’t be able to enroll in Medicare Supplement Plan F (the most comprehensive plan) with guaranteed issue under this birthday rule because Plan F provides greater coverage that Plan A. Also note that as a California resident, you may technically change your Medicare Supplement plan at any time during the year, but you wouldn’t be subject to medical underwriting during the annual “birthday rule” period. You’ll also have these protections if you’re eligible for guaranteed-issue rights in certain situations; for example, if you were enrolled in a Medicare Advantage plan and you move out of the plan’s service area, you can enroll in certain Medigap plans with guaranteed issue (if you decide to go back to Original Medicare).
Medigap plans in California and the rest of the United States do not offer prescription drug benefits. If you need help to cover medication costs, you may want to enroll in a stand-alone Medicare Part D Prescription Drug Plan. These plans are available through private insurance companies that are contracted with Medicare.
As mentioned, to sign up for a Medigap plan in California, you must already be enrolled in Original Medicare, Part A and Part B. And note that even if you sign up for a Medicare Supplement plan, you must remain enrolled in Original Medicare, Part A and Part B, and go on paying your Medicare Part B premium, to keep your health insurance coverage. Medigap plans in California aren’t meant to provide stand-alone health coverage; they’re only meant to work alongside Original Medicare and help pay for certain out-of-pocket costs.
Types of Medigap plans in California
It may be a good idea for you to review each Medigap plan in your area before deciding which plan to join, since availability, benefits, and costs may vary. Here’s a look at the benefits you may be eligible to receive under each of the 10 standardized Medigap plans in California. In this chart, X indicates that the service (or item) is 100% covered; a percentage indicates what percent of the service/item is covered; and a blank cell indicates it is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F1||G2||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X4|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B excess charges||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Out-of-pocket limits apply.3|
1As of January 1, 2020 people new to Medicare can’t buy plans that cover the Medicare Part B deductible. This means that Medicare Supplement Plans C and F will no longer be available to new Medicare enrollees. However, if you already have a Plan C, Plan F, or high-deductible Plan F, you can keep it. If you were eligible for Medicare before January 1, 2020, you also may be able to buy Medicare Supplement Plan C, F, or high-deductible Plan F.
2 Plan G will offer a high deductible option beginning January 1, 2020
3Once you reach the out-of-pocket limits (including the Part B deductible), both Medicare Supplement Plans K and L pay 100% of covered services in the above chart for the remainder of the calendar year.
4Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, except for a copayment of up to $20 on doctor visits and up to $50 on emergency room visits that don’t result in an inpatient admission.
Choosing a Medigap plan in California
As mentioned, Medicare Supplement plans in California with the same letter designation offer the same standardized benefits. However, as you compare plan options, keep in mind that premium costs may vary, even for the exact same benefits. Each insurance company that sells Medicare Supplement plans is allowed to determine its own monthly premium structure, and the type of method used can affect your premium costs both when you first enroll and later on.
Because costs vary by plan and insurance company, this means that if you live in San Francisco, in San Francisco County, you may pay more or less than a resident of Palm Springs in Riverside County for an identical Medicare Supplement plan. It may be a good idea for you to compare all Medicare Supplement plans available in California in order to select the plan that best fits your personal health and budget needs.
Get additional information about Medicare plans in California by accessing the following article:
With so many Medicare Supplement plan options in California, it may be a good idea for you to understand what each plan has to offer before making your choice. To get help selecting the Medigap plan that works best for your individual health needs, feel free to start browsing plan options now using the plan finder tool on this page. Or, if you prefer, get help with your Medicare coverage questions by contacting eHealth and speaking with a licensed insurance agent.