Medicare Plans

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With healthcare in California constantly changing, it is important to know which plan is right for your specific needs. To help understand Medicare coverage, we’ve created a quick overview below:

 

Medicare Part A

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Most seniors are enrolled in Medicare Part A when they reach 65 years of age. Medicare Part A covers medical needs such as hospital care, skilled nursing facility care, hospice care, and limited home health care.

Seniors that have 40 or more quarters of Medicare-covered employment receive Medicare Part A free of premium cost. However, those with below 40 quarters of Medicare-covered employment may have to pay for a portion of the Part A premium of Medicare. 

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Medicare Part B

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Enrollment for Medicare Part B is not automatic when one turns 65, therefore, seniors must enroll for Part B when turning 65, or when they are no longer covered by employer-sponsored health coverage. Part B covers basic medical needs including physicians services, outpatient hospital services, some home health services, and medical equipment. In 2023, the monthly premium for Part B is $164.90, but can vary depending on income. The premium for Part B is often deducted automatically from a senior’s Social Security check. The current deductible for Part B in 2023 is $226.00.

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Medicare Part C

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Medicare Part C is also known as the Medicare Advantage Program, which entails private health insurance plans that follow Medicare requirements and can be used as a replacement of Medicare Parts A and B. Medicare Part C pays for everything that Medicare Part A and B covers, but may cover additional medical costs. While Part C monthly premiums can vary, monthly cost generally lies between $0 and $100. Medicare Advantage Plans can provide additional coverage for medical expenses such as prescription drug coverage. When a senior purchases a Medicare Advantage Plan, the premium, deductible, co-pay, and co-insurance are determined by the health plan. These plans are most often HMO plans in California.

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Medicare Part D

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Medicare Part D is coverage for prescription drugs and is purchased separately. Prescription Drug plans are available for purchase from a variety of carriers, as well as directly from Medicare. There are many variations of Part D plans in the cost of deductibles, cost sharing, etc.

 

Medicare Supplement Plans

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Medicare Supplement plans are private plans that are also known as Medigap plans. There are a variety of Supplement plans available, which are standardized and identifiable by letters (A-N). Each Supplement plan offers varying levels of coverage, intended to fill any gaps that are experienced by those with Medicare coverage. Due to the standardization of Supplement plans, each plan of a certain letter must offer the same coverage. These plans charge a monthly premium and will cover additional costs once Medicare pays for their portion of the medical services.​

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CA Insurance Code 10192.11 (h) (1) An individual shall be entitled to an annual open enrollment period lasting 30 days or more, commencing with the individual's birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage. During this open enrollment period, no issuer that falls under this provision shall deny or condition the issuance or effectiveness of Medicare supplement coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract. An issuer shall notify a policyholder of his or her rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period.

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​“Birthday Rule” for Medicare Supplements in California

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​Annual Open Enrollment is available for those who are covered by a Medicare Supplement plan. This is known as the “Birthday Rule”. The birthday rules allows any senior to enroll in carrier’s Supplement plan that is equal or provides less than the current Supplement plan, without underwriting on their birthday, plus 60 days thereafter in replacement of their current Supplement plan.

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Discounts

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The “New To Medicare” Discount is offered by Blue Shield of California, which provides a discount of Medicare Supplement Plans A, C, D, F, F Extra, and G. The Discount ranges from $25 per month, and an additional $3/mo discount is available to those who choose to use Easy$Pay to pay their premiums. ​Additionally, all Blue Shield Medicare Supplement Plans include a free Silver Sneakers Fitness Program. Plan F and F Extra are only available to individuals whose Medicare eligibility is available prior to January 2020.

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Anthem Blue Cross also offers a “New To Medicare” discount of $25 per month on Plan G for the first 12 months. An additional $2 per month discount is provided if seniors choose to enroll in autopay. Anthem Supplement plans also include a free Silver Sneakers Fitness Program.

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