Medicare Advantage Plans in California

If you don't like the coverage provided by Original Medicare, the alternative is a private health plan through the Medicare Advantage program. In most areas of California there are multiple options to choose from, but options vary between each California County. As a result, you can only choose a plan that's available where you live.

You can compare all the available plans in your area by using our zip code lookup tool above or by clicking on your county below. Continue reading to find out more about California's Medicare Advantage program and how it compares to other options.

Compare the Best Medicare Advantage Plans in California by County

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

The advantages of 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). are found in what they can cover that Original Medicare cannot. Specifically, the MA plans (aka, Part C of Medicare) available in California can include minor healthcare benefits such as prescription drug coverage, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services. To join a plan you must first be enrolled in 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..

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.

Medicare Advantage vs. Original Medicare: Is There a Big Difference?

The best way to understand the differences between Medicare Advantage and Original Medicare (Medicare Part A and Part B) is to evaluate the pros and cons of each type of coverage.

The Pros and Cons of Medicare Advantage Plans vs Original Medicare

1. With Medicare Advantage you must use California healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved providers of your choice.
2. If you travel and have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death., Medicare Advantage covers you (in the U.S and its territories only). However, if you are a snowbird and winter or summer in another state, a non-emergency doctor outside of your plan's network won't be covered.
3. All Medicare Advantage plans sold in California protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
4. Most Medicare Advantage plans come bundled with a California 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 for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
5. With Original Medicare, your costs (copays, coinsurance, etc.) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
6. 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 Medigap Coverage vs. Medicare Advantage

Three of the most common questions we get from California seniors are:

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

Let's answer these three questions right now.

Why California Medicare Advantage Plans are Bad

This is a myth. There's nothing wrong with Medicare Advantage plans. Over 42 percent of all Medicare beneficiaries in California choose Medicare Advantage enrollment over 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.. What you really need to know is that these plans are not for everyone, and for some California seniors they are a disadvantage.

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 Medicare 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 premium, 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).

Medicare Advantage plans have a monthly premium, but it's generally less than a Medicare supplement, and some plans even have a $0 premium. But, you also pay when you use health care. These are the copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). Most of 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. come when you use healthcare services.

With a Medicare supplement plan, you pay most of your costs in advance with monthly premiumsA 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. . Depending on the level of coverage you choose, the plan can cover all of your copays, coinsurance, and deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. except the annual Part B deductible. This makes your monthly healthcare costs more predictable, particularly if you have serious health problems.

Which is Best in California, Medicare Advantage or Medicare Supplement Insurance?

1. If your budget allows, keep your Original Medicare benefits and a Medicare Supplement 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. These are the top 3 best Medigap plans that can help you manage your out-of-pocket costs the best, giving you complete peace of mind.
2. 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 pay just a little to see your doctor (up to $25 per visit).
3. If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
4. If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you 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.
5. If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
6. 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.
7. 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).
8. 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.
9. 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 return 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 June 29, 2022.