Medicare is a federal health insurance program with four main parts: Parts A, B, C, and D. Together, Parts A and B are known as ‘Original Medicare,’ offered by the government.
U.S. citizens age 65 or older OR those who have been legal residents for at least five years and are 65 or older. They or their spouse have worked for at least ten years (or 40 quarters) in Medicare-covered employment are eligible for Medicare coverage. Someone under the age of 65 may also qualify for Medicare if they meet the criteria for specific disabilities. Requirements may vary among different Medicare plans.
Click the link to see if you are eligible for Medicare and calculate your premium.
Eligibility for Medicare Part A Hospital Insurance:
- You are at least 64 years and nine months old, or; You are under the age of 65 but living with specific disabilities or conditions; o Have End-Stage Renal Disease (ESRD).
Eligibility for Medicare Part B Medical Insurance:
- You are at least 64 years and nine months old, or under the age of 65, but living with a specific disability or condition; o Have End-Stage Renal Disease (ESRD).
Medicare Part C Eligibility (Medicare Advantage Plans, offered in California):
- You are entitled to Part A, and You are entitled to Part B, and You do not have End-Stage Renal Disease (ESRD) unless you meet an exception and You live in the plan’s service area.
Medicare is a federal health insurance program with specific enrollment rules to navigate that we will cover in this article. Go here to read more about the four parts of Medicare.
As with the other states, private companies are operating in California that offer health care plans that work with Medicare to provide health insurance to those who qualify. We will go into detail in this article.
California Medicare Eligibility Guidelines
There are four ways to be eligible for Medicare in California:
- Are 65 years of age or older Have End-Stage Renal Disease (ESRD) Have Lou Gehrig’s Disease (ALS) Are currently receiving Social Security Disability Insurance (SSDI) for more than 25 months.
Once you have confirmed that the eligibility requirements have been met, you can begin shopping for the various health plan solutions.
Medicare health plans in California
Although there are hundreds of Medicare health insurance plan options in California, there may only be a few available to you that make sense for your needs. Remember that Original Medicare (the government-sponsored health insurance plan) is NOT the same as California’s privately-owned Medicare Advantage and Medicare Insurance plans.
Original Medicare is made up of Part A and Part B and is what you’ll start with when you become eligible for Medicare. You can read more about the four parts of Medicare here.
Once you have Part A and Part B, most people will decide between signing up for the following options.
- Medicare Advantage Plan with Medicare Part D prescription drug coverage. Medicare Supplement with Medicare Part D prescription drug coverage. Stand-alone prescription drug coverage plan (part d).
Medicare Advantage Plans in California
Medicare Advantage plans in California are great options for those who want health insurance benefits and those strictly available through Original Medicare.
Contrary to what you may have heard, Medicare advantage plans still require all of your Part A and Part B benefits, but they can have more, too!
Additional health insurance benefits may include:
- Fitness ProgramsMeal DeliveryDentalVisionHearingNon-Emergency Transportation
Need help making your California Medicare enrollment decision? We suggest that you list the health care benefits you need before you start looking for Medicare coverage from any insurance company. Also, make a list of the doctors and pharmacies you like to visit and the prescriptions you are currently taking. Make sure the plan you select covers all your needs.
Enrollment details for Medicare Advantage plans
Enrollment in Medicare Advantage plans occurs annually between October 7 and December 15. This is called the Annual Election Period, and it’s the period when most registrations in the Medicare Advantage plan occur.
If you have just turned 65 and are eligible for Medicare, your initial enrollment date will be effective the first day of your birth month. For example, if her birthday is May 15, her Medicare effective date will be May 1.
Medicare Supplement Plans in California
If Medicare Advantage isn’t suitable for you, you may consider Medicare Supplement plans.
These plans are often called “Medigap” because they bridge the gap between what Medicare covers and your out-of-pocket costs.
Medigap plans generally don’t include all of the extra benefits that Medicare Advantage plans can provide. Instead, Medigap plans may cover your Part A and Part B premiums, deductibles, copays, and coinsurance.
What is the cost of Medicare in California?
Your costs will be standardized if you stick to the basics (Part A and Part B).
Most people will have Part A at no premium (unless they have paid no Medicare taxes). The standard Part B premium for 2021 is $148.50 per month, and the standard deductible is $203 per year.
Most people won’t pay less or more, but those numbers can be adjusted based on your income.
If you join a Part D plan, your costs will be slightly different depending on your plan. However, the standard deductible for 2021 is $445. Prescription drug plan premiums can be as low as $13 or as high as $80 per month.
If you enroll in California Medicare Advantage Plans or Medicare Supplement plans, you will have a different premium.
Some $0 premium Medicare Advantage plans may be available in your area. If you’re not paying a premium, your deductible and copays are likely to be a little higher.
Lastly, the costs of Medicare coverage can vary depending on where you live. For example, premiums for Medicare Advantage plans in Los Angeles may be utterly different than premiums in Sacramento.
California Medicare Part D Prescription Drug Discount Program
Did you know that Medicare beneficiaries in California have access to drug prices at the Medicaid level?
No matter what prescription drug coverage you have, you can get great discounts as long as you have your Medicare card to show you have Medicare coverage.
When you pick up your prescriptions, show your Medicare card at the pharmacy and ask for the Medi-Cal reimbursement price. If the Medi-Cal price is lower, they may give you that price instead.
Keep in mind that if you have an excellent Part D or Medicare Advantage plan, there’s a chance that it may be cheaper for you to use your Medicare plan than to use the Medi-Cal discount.
Always make sure the price is lower before you go that route. Also, only pharmacies that accept Medi-Cal coverage can offer this discounted price, so your favorite pharmacy may not participate in this program.
Can I have Medicare and Medicaid in California?
Medi-Cal is what refers to those in California with Medicaid benefits.
Qualify for Medicare and meet the income requirements for California Medicaid (Medi-Cal). You may be eligible for plans that have benefited from both programs, known as Dual Special Needs Plans (SNPs). These types of Medicare Advantage plans were created specifically for this scenario.
DSNPs generally cover most, if not all, of your health care costs.
How do I sign up and qualify for Medicare?
Ready to sign up for Original Medicare? For most, enrollment in Part A is automatic when you turn 65. If you’re not automatically enrolled, or if it’s time to sign up for Part B, your options are:
Visit www.socialsecurity.gov
Call Social Security at 800.772.1213 (TTY 800.325.0778)
Visit your local Social Security office in Alameda, Contra Costa, Placer, Sacramento, Santa Clara, and Yolo counties.
- Alameda County Social Security Office Locations Contra Costa County Social Security Office Locations Placer County Social Security Office Locations Sacramento County Social Security Office Locations Santa Clara County Social Security
Download the Medicare application you need and mail it or take it to your local Social Security office.
Conclusion
Medicare can be a complex program to understand, and Nivano is dedicated to making it easy for you to navigate to make the best possible decision for you.
If you have specific questions, please contact the Nivano Medicare Hotline at 866-674-3959. We have state-licensed agents ready to answer all of your questions.
