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Medicare Advantage Plans in California

Medicare Advantage plans, sometimes referred to as Part C, are offered by private companies that are approved by Medicare, and consist of Parts A and B and sometimes Part D. Each policy has a premium except Part A, for most beneficiaries.

If you want all your coverage in one plan, you may want to consider the Medicare Advantage plans in California. You can choose from a variety of plans, each of which offers different insurance benefits.

The Types of Plans Available

Unlike Original Medicare (Parts A and B), you secure your Medicare Advantage plan from an independent insurance agent. Medicare Advantage plans in California include the following options in terms of the type of plans available:

  • HMO — With an HMO, you have one primary doctor. This is your “medical home.” You see this doctor first for everything. If the doctor feels there’s a condition or issue that is out of their scope, you may receive a referral to a specialist. HMO plans are typically less expensive than other managed care plans. This makes them a good choice for many Medicare beneficiaries.
  • PPO — The PPO, or Preferred Provider Organization, is a network of doctors on your plan. If you see a doctor within the network, you receive the most substantial benefits. These doctors have contracted rates with Medicare, and you can take advantage of these lower rates by staying within the network. You typically will not need a specialist referral if you stay in-network. If you do go outside of the network, you may still have coverage, just at a lower percentage. This means you’ll have higher co-insurance balances.
  • SNP — The Special Needs Plan is for individuals with very low income, who have a chronic illness, or who live in a nursing home. The SNP helps manage the care of those who need it most. SNP’s also include prescription plans.

Note: Typically, Medicare Advantage plans include PFFP and Medical Savings Account plans. As of 2019, however, California doesn’t offer PFFP (Private Fee-for-Service) or Medical Savings Account plans.

What Does Medicare Advantage Cover?

Medicare Advantage includes the same basic benefits of Medicare Parts A and B. The only exception is hospice. Hospice care falls under your Medicare Part A even if you have a Medicare Advantage plan.

In addition, some plans offer coverage for dental, vision, hearing, or prescription medication. Before selecting a plan, ensure you are clearly aware of all it has to offer as each plan differs from one another.

Typically, Medicare Advantage plans offer prescription coverage. This is the most considerable advantage of choosing a Medicare Advantage plan versus Medicare Parts A, B, and D. Many beneficiaries also select Medicare Advantage plans for dental or vision coverage. In addition, some plans offer wellness benefits, which Medicare Part B does not provide.

Eligibility for Medicare Advantage Plans in California

You are eligible for Medicare Advantage plans in California if you meet the following requirements:

  • You reside within the service area of the insurance provider of the plan.
  • You are enrolled in or eligible for Medicare Part A and Part B.
  • You don’t have end-stage renal disease.

Note: If you are diagnosed with end-stage renal disease while you have a Medicare Advantage plan, you do not lose your coverage.

Enrolling in Medicare Advantage Plans in California

Just like group health insurance, there are certain times when you can enroll in Medicare Advantage plans in California.

The first period occurs the year you turn 65. You may sign up for a Medicare Advantage plan three months before your birthday, through the month of your birthday and the three months after that. Basically, a seven-month window.

If you miss your window to enroll in Medicare Advantage, you’ll have another chance during the Open Enrollment Period, which occurs October 15–December 7 each year. The coverage you choose at this time becomes effective on January 1, the following year.

If you already have a Medicare Advantage plan, you also have the period January 1–March 31 to drop the plan or change plans. If you drop Medicare Advantage, you can take regular Medicare Part A and B again. If you wish, you can also pick up Medicare Part D for your prescription drug coverage at this time.

Paying for Medicare Advantage Plans in California

Each insurance company charges different premiums for its insurance program. In general, you pay the Medicare Part B premium plus a monthly premium for the other coverage offered to you in your Medicare Advantage plan. You are free to compare plans before you buy one. You may also comparison shop during your open enrollment period if you find that your plan doesn’t suit your needs or is too expensive.

Medicare Advantage Plans and Medicare Supplement Plans

If you’re paying for a Medicare Supplement plan or Medigap and you enroll in a Medicare Advantage plan, you should drop the Medigap plan as it is not necessary to have both. Unless you cancel it, though, you’ll continue paying premiums.

By law, insurance providers cannot provide you with a Medigap policy if you have Medicare Advantage. The only way to use your Medigap policy is to switch back to Medicare Part A. If you want to disenroll from your Medicare Advantage plan, you must wait until open enrollment to cancel the policy.

Medicare Advantage plans in California offer a more inclusive way to obtain insurance coverage. It’s worth looking at all your options, including the premiums. Think of what you typically use insurance for and how much you pay out-of-pocket. You can then use this as a guide to help you choose your Medicare programs for at least the next year. You always have the Open Enrollment Periods to switch Medicare Advantage plans or go back to original Medicare Part A and Part B if you change your mind.

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