Home Health Understanding Medicare in California

Understanding Medicare in California

Medicare California

If you live in California and are about to turn 65 years old or are gearing up for the upcoming Medicare open enrollment period (which runs January 1 through March 31), you’ve likely got questions.

What are the eligibility requirements in California? What types of Medicare coverage are available, and how much do they cost? How do you choose the best Medicare Advantage plan provider?

If you find yourself asking these questions, we’ve gathered details to help you better navigate the Medicare open enrollment process.

Who’s Eligible for Medicare in California?

To be eligible for Medicare in California, you must be age 65 or older, under age 65 and have received Social Security Disability Insurance (SSDI) for 24 months, or have either end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS.) The Social Security Administration oversees determining overall eligibility for individuals.

What Medicare Coverage Types are Available in California?

Throughout the Golden State, there are four Medicare plan options available, which include Medicare Part A (hospital-related expenses), Part B (medical-related expenses), Part C (more commonly known as Medicare Advantage plans), and Part D (prescription drug coverage).

Part A premiums are generally covered if you or your spouse worked 10 years or more at a company that deducted Medicare taxes during each payroll period. Meanwhile, Part B costs are generally standardized based on the modified adjusted gross income reported on your IRS tax return two years prior to your Medicare application year.

Plan B costs range from $170.10 per month for individuals earning $91,000 or less ($182,000 or less for couples) to $578.30 per month for individuals earning $500,000 or more ($750,000 or more for couples.) Part D premiums may be covered by either your Plan A or Plan B premium if your income is $91,000 or less or may cost as much as an additional $77.90 per month for individuals earning $500,000 or more. Part C plans, or Medical Advantage plans, are optional coverage plans that many opt for to help cover expenses not covered by Plan A or B.

What Should I Consider Before Choosing a Medicare Advantage Plan?

Medical Advantage plans are a bit more limited within California, as providers and pricing vary based on zip codes. For instance, you may choose 16 providers in Los Angeles County, but eligible residents of less populated areas like Sonoma County have fewer provider options. 

Plan pricing varies by zip code and provider, too. In fact, as of 2022, the average cost for Medicare Advantage plans in Los Angeles County was $8 per month, while the average in Sonoma County was $43 per month.

Anotessentialtant factor to consider is that not all doctors or hospitals accept every Medicare Advantage plan provider. This means if you want to keep your current doctor or hospital, you’ll need to choose one they accept. Steps for choosing a Medicare Advantage plan provider include:

  1. Determining which are available in your zip code
  2. Determining which are accepted by your preferred doctor(s) and/or hospital(s)
  3. Reading reviews and recommendations from trusted sources

If you need additional guidance, contact the California Department of Aging’s Health Insurance Counseling and Advocacy Program (HICAP) for support. The counseling they provide is confidential and free of charge.

Making an Informed Choice

Once you become eligible for Medicare, Part A, B, and D plans will be fairly straightforward, with the major differences depending on your income. On the other hand, Part C (Medicare Advantage plans) will take a bit more research. After determining which providers are available in your zip code and are accepted by your preferred doctor and hospital, the next important step is to consult the reviews of trusted industry leaders, as well as take advantage of free counseling before deciding.