Medicare in California

California is the most populous state in the U.S. and includes everything from massive cities to small towns. This variety also means that there are many different forms of Medicare available to you depending on if you live in a rural or urban city.

If you opt for the federally funded Original Medicare, then your eligibility is the same as essentially anywhere else in the country. You must also be 65 years old and have paid Medicare taxes while working. You also can be eligible for Medigap, which helps you cover some of the costs associated with Original Medicare, like copayments, coinsurance and deductibles.

Additionally, California has numerous local options available through Medicare Advantage, which can vary by state. These plans are available through private insurance companies and will cover at minimum everything included in Original Medicare. Medicare Advantage plans often include added benefits and coverage.

According to the U.S. Centers for Medicare & Medicaid Services, 99% of California residents with Medicare have access to a Medicare Advantage plan.

Since Original Medicare is a federal program, you should be able to enroll without any major state-specific requirements or regulations. This includes Part A, which covers inpatient and hospital care, and Part B, which focuses on outpatient care.

Part A is premium-free for most people, but you will have to pay a monthly premium of $164.90 for Part B in 2023. This premium can be higher depending on your level of income.

There are also many Medicare Advantage options available. There were 492 plans in California in 2023, with an average monthly premium of $16.42

Medicare Advantage plans in California include additional benefits like wellness and health care planning or rewards and incentive programs. Since private insurers provide Medicare Advantage plans, plan availability and benefits will vary by where you live in the state.

In addition, Medicare Advantage plans typically include a network for beneficiaries.

Medigap supplement insurance is also available through private insurers, but the group of plans available offer the same coverage everywhere regardless of the insurance company you use.

Medigap plans are meant to help with the costs of Original Medicare and can’t be used if you have Medicare Advantage.

A Medicare Part D prescription drug plan is often available as part of a Medicare Advantage plan, but California also has 25 stand-alone prescription drug plans.

California also has its own Medicaid program, Medi-Cal. Medi-Cal is available if you have a severely limited income or resources and cannot easily afford health care.

When you turn 65, you will have a multi-month window to get Original Medicare. You can enroll in the three months leading up to your 65th birthday and the three months after.

You can also purchase Original Medicare by phone if you call 1-800-772-1213, or online as well. Those who are already taking Social Security are automatically enrolled.

Medicare Advantage plans are available as separate plans through private insurers, so you can get Medicare coverage through those companies.

You are eligible to buy Medigap within a six-month window once you enroll in Original Medicare.

According to the U.S. News & World Report, four insurance companies stand out for Medicare in California.

Like other Medicare Advantage plans, these insurers frequently offer additional benefits with their coverage.

For example, Kaiser Permanente includes wellness and fitness programs, drug coverage and may even help pay for hospice care. Scan Health Plan provides vision and dental coverage like contact lenses or glasses and diagnostic dental exams. Sharp Health Plan includes foot exams and treatment, and WellCare can offer fluoride dental treatment and routine foot care.

Different plans come with various perks and benefits, so consider your priorities and what you want to cover before selecting a plan.