What are Medicare Advantage Plans and Can I Get One in California?
The advantages of Medicare Advantage (MA) health plans are found in what they can cover that Original 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.... 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 A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... and Medicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care.....
Althought the extra benefits, particularly a prescription drug plan, are nice to have, it's important to fully understand what you're getting if you enroll in a Medicare Advantage plan in California. Specifically, Medicare Advantage is managed care health insurance and the plan controls your access to healthcare providers. If you have ever had an HMO plan through your employer's group health insurance, you have a good idea of what a managed care insurance plan is all about.
Original Medicare vs. California Medicare Advantage Plans: How Do They Compare?
The best way to understand the differences between Medicare Advantage and Original Medicare coverage is to evaluate the pros and cons of each type of coverage.
The Pros and Cons of California Medicare Advantage Plans vs Original Medicare
- 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 (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 emergency.
- With OriginalMedicare there are no limits on your Out-of-pocket costs (aka, out-of-pocket medical expenses) are costs that a beneficiary must pay because their health insurance does not cover them. Out-of-pocket costs are found in the deductibles, copayments, and coinsurance outlined in each health.... 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 Coinsurance 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 D is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.... 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 A 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 disease (ESRD) or one of a handful of other diseases.
California Medicare Advantage Plans vs. Medigap
Most California seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- 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 take a minute or two to compare and contrast, shall we?
Why California Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in California choose Medicare Advantage enrollment over traditional Medicare.
What you really need to know is that these plans are not for everyone, and for some California seniors they are a disadvantage. Some people are better served with Original Medicare and a Medicare supplement. The question is, which option is best for you?
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people, people with Medicare Advantage retiree benefits, and for people who qualify for both Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.....
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly A 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 when they are well.
You can check out supplemental Medicare insurance in California on our California Medicare supplements page.
Are There Disadvantages to Joining a Medicare Advantage Plan in California?
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 most Medicare Advantage plans you pay a little each month (the monthly premium) and A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.... when you use medical services. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). You pay the majority of your costs when you use health services.
With most Medigap plans you pay most of your costs upfront with your monthly premium. As a result, your costs (e.g., the deductible) are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services
Is it better to have Medicare Advantage in California or Medigap?
- If you can afford Medicare 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.... or G, then keep your Original Medicare and add one of these supplements. These plans help you manage your out-of-pocket costs the best, giving you complete peace-of-mind.
- If you are a healthy senior and have good health in your family heritage, Medicare 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).
- 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
- 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 Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- 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 premium (it typically comes straight out of your Social Security income, unless you're not yet taking it).
- With Medicare 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 period 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.
Frequently Asked Questions About California Medicare Advantage Plans
California Medicare Advantage plans are not statewide, they are local. So, the only way to answer this question is to enter your zipcode here.
More than 90% of all Medicare Advantage plans in California include a Part D plan for prescriptions, but not all. However, coverage is different with each plan. It is very important to verify that a plan covers your most important medications before you join. You can do so using this tool.
Some people love Medicare Advantage while others hate it. The only way to determine if it will work for you is to compare your health and financial situation with the plans available in your area. In this article you will learn how to do just that.
Compare the Best Medicare Advantage Plans in California by County
Citations & Referencesmedicare.gov
- Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
- Medicare.gov: the official U.S. government site for Medicare | Medicare https://www.medicare.gov/
- Find a Medicare plan https://www.medicare.gov/plan-compare/
- Medicare Benefits | SSA https://www.ssa.gov/medicare/
- Extra Help with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
- Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/
- Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
- Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...
The Medicare Advantage plan information on this page is maintained by David Bynon and was last updated on .