Medicare Advantage Plans in California

Medicare is not a one-size-fits-all system. California Medicare beneficiaries have options. One option is a Medicare Advantage plan. These local health plans replace your Original Medicare benefits with private health insurance. However, because the plans use local providers, you must shop plans available where you live (i.e., you California County).

Use our zip code lookup above to see which plans are available in your region. Or click below to select your county. Keep reading to learn more about the Medicare Advantage program in California.

Compare the Best Medicare Advantage Plans in California by County

What are Medicare Advantage Plans and Can I Get One in California?

Unlike Original Medicare, which only covers major medical costs, a Medicare Advantage plan, sometimes called Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all..., can include many extras, including prescription drug coverage, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in California. But you must have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits to join a plan.

While it is nice to have coverage for minor medical costs, such as a prescription drug plan, you must understand exactly what you get when you join a Medicare Advantage plan in California. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care insurance plan (HMO, PPO, etc.) through an employer, you already know what to expect.

Original Medicare vs. Medicare Advantage in California

The big differences between Original Medicare coverage and what you get with a Medicare Advantage plan in California are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.

Pros and Cons: Medicare vs. Medicare Advantage

• When you have Original Medicare, you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of California providers.
• If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with California Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B)., which are only required to cover you if you have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death..
• With Original Medicare, there are no limits on your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. However, all California Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. , the plan picks up the tab for the remainder of the year.
• If you want prescription coverage and have Original Medicare, you must purchase a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan. However, most Medicare Advantage plans include a California Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
• In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system, deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
• There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

California Medicare Supplements vs. Medicare Advantage

We're frequently asked:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans in California?
• Is it better to have Medicare Advantage or Medigap?

Let's take just a minute to dispel any misconception that these plans are bad or might have serious disadvantages.

Why California Medicare Advantage Plans are Bad

People that say Medicare Advantage plans are bad simply misunderstand them and don't know how they work. Over 42 percent of all Medicare beneficiaries choose Medicare Advantage enrollment and like their care. However, these plans are not suitable for everyone living in California.

A good way to figure out which coverage is best for you is to look at your health and your finances. If you have one or more chronic conditions and you can afford a supplement, traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. is likely the best option because you have the ability to choose your doctors. Conversely, if you are super healthy, or you are unable to afford a Medicare supplement, then Medicare Advantage is a viable option.

Here's the fundamental truth. Medicare plus a Medigap plan works best for people with chronic health conditions. It's also the best coverage for people who can afford a higher monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , even if they rarely see a doctor.

You can learn more about what Medicare supplements are available to you on our California Medigap Plan Finder page.

What are the Disadvantages of California Medicare Advantage Plans?

As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay. This fact remains the same no matter what type of Medicare Advantage plan you are considering (e.g., HMO, PPO, PFFS, Cost, or HSA).

With Medicare Advantage, you pay a little each month (with some plans, you pay nothing). This is the monthly premium. But you also pay copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.

However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.

Is it better to have Medicare Advantage in California or Medigap?

• If you can afford Medigap Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N, keep Original Medicare and add one of these top 3 Medicare supplements. These plans help you manage your out-of-pocket costs the best, giving you peace of mind.
• If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and you pay just a little to see your doctor (up to $25 per visit).
• If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is good. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
• If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and do not qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. (dual eligible), the most Medigap coverage you can afford is the best option.
• If you qualify for both Medicare and Medicaid, Medicare Advantage is your best option regardless of your health condition.
• If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
• With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
• With Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
• Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on August 27, 2022.