Medicare Advantage Plans in California

A Medicare Advantage plan in California is an alternative to Original Medicare for beneficiaries at least 65 years old or with end-stage renal disease. While you're still a Medicare beneficiary and should keep your red, white, and blue Medicare card in a safe place, you will use your Medicare Advantage card once your coverage begins.

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Top-rated Medicare Advantage Plan Providers in California

Here are some of the private insurance companies offering Medicare Advantage plans for 2022:

  • Aetna Medicare.
  • Alignment Health Plan.
  • Anthem Blue Cross.
  • Aspire Health.
  • Astiva Health.
  • Blue Shield of California.
  • Brand New Day.
  • Central Health Medicare Plan.

Here's what you need to know about Medicare Advantage plans in California:

  • Private insurance companies offer Advantage plans authorized by the federal government.
  • These companies are required to follow the rules set by the government.
  • All Advantage plans are required to provide Medicare coverage equal to that offered by Medicare Part A and Part B.
  • Most plans add benefits that you can't get through Original Medicare or Medicare Supplement Insurance.
  • Most Medicare Advantage plans reduce out-of-pocket costs while enhancing benefits.
  • You will still have some expenses out of pocket, like the Part B premium and coinsurance.
  • Some $0 premium plans will return some or all of the Part B premium as a social security check rebate.

Popular Medicare Advantage Plans in California

Medicare Advantage PPO

  • PPO offers an extensive network of covered healthcare providers, hospitals, and other healthcare professionals.
  • Out-of-network coverage is allowed with higher out-of-pocket costs.
  • Primary care physicians and referrals aren't required.

Medicare Advantage HMO Plan

  • Many plans offer $0 premiums.
  • An extensive referral network lowers out-of-pocket costs.

Medicare Advantage D-SNP

  • Beneficiaries with chronic conditions or low income under dual eligible special needs plans are provided additional coverage.
  • Beneficiaries can use Medicare and Medicaid together to cover copayments, coinsurance, and other out-of-pocket expenses more thoroughly.

California Enrollment Facts:

  • 42% of Medicare beneficiaries nationwide are enrolled in Medicare Advantage plans
  • 43% Of Medicare beneficiaries are enrolled in California.

When to sign up for Medicare Advantage Plans in California

Initial Enrollment Period

Your first eligibility period starts three months before you turn 65 and ends three months after. That gives you seven months to consider your enrollment options, compare rates and benefits from various insurance companies, and make sure an Advantage plan is the best option.

Open Enrollment Period – AKA Annual Election Period

The annual Medicare Open Enrollment Period runs from October 15 to December 7. It allows you to enroll in an Advantage plan or go back to Original Medicare if you don't like your Advantage plan.

Medicare Advantage Open Enrollment Period

From January 1 to March 31 each year, you can switch to a new Medicare Advantage plan or return to Original Medicare. You cannot use this enrollment period if you are not already enrolled in an Advantage plan.

Special Enrollment Periods – Special Circumstances

You may have the option to enroll in an Advantage plan outside of the annual and initial enrollment periods due to special circumstances. Some of the more common special events include:

  • You move out of the service area for your current plan and must select a new one.
  • You lose health care insurance from a private insurer.
  • You move back to the United States after living in a foreign country.

5-star Special Enrollment Period

Insurance companies are rated by Medicare annually based on information obtained from healthcare providers and beneficiaries, plus an analysis of their plans. The best rating possible is a five star.

If a five-star Medicare Advantage plan becomes available in your area, you have the option to switch to that plan between November 8 and December 30. You can only use this special enrollment period one time.

Special Enrollment Periods if you get "Extra Help."

If you receive Extra Help or have Medicaid, you have three special enrollment periods. You can only make one change to your California Medicare Advantage plan or drug coverage each period.

  • January – March
  • April – June
  • July – September

Signing up for Medicare Parts A and B is your first step. You may also want to read a complete description of benefits to know what Medicare covers without additional Medicare health plans.

Did you enroll in a Medicare Advantage Plan in California for 2021?

Unless you're enrolled in Medicare Part A and Part B early due to a disability or End-Stage Renal Disease ESRD, your first chance to sign up for Medicare Part C in California is during your Initial Coverage Election Period (ICEP). This window opens three months before your 65th birthday and closes three months after your birthday, giving you seven months to enroll.

Use that time to compare the best rates and terms online because each insurance company determines the coverage provided in each Medicare Advantage plan. Other than covering your standard Medicare Part A and Part B benefits, there are no standardized benefits for a Medicare Advantage plan in California.

In many cases, your Medicare Advantage ICEP will run simultaneously with your Original Medicare Initial Enrollment Period (IEP). You can waive Part B of Original Medicare if you don't want to pay the premium, but that disqualifies you from Medicare Advantage plan enrollment.

If you don't sign up for a Medicare Advantage plan in California during the initial coverage election period, you can sign up during the Medicare Advantage plan Annual Election Period (AEP). This period runs from October 15 to December 7 each year and gives you the best chance to switch from standard Medicare Part A and Part B to a Medicare Advantage plan. Due to special circumstances, you may also qualify for Special Election Periods (SEP) outside of the Annual Election Period. For example, when a company does not perform a contract renewal for its Medicare contract, then you will have an option to shop for another health insurance company to purchase your Medicare coverage. If you move out of your provider network or lose your coverage through your job, you'll also have the opportunity to buy a plan.

Do you want to cancel your Medicare Part C policy and return to Original Medicare to receive basic Medicare Part A and Part B benefits? Take advantage of the Medicare Advantage Disenrollment Period, which is open from January 1 through February 14 annually.

What is the best Medicare Advantage Plan in California?

While there are a variety of Medicare Part C plans in California available in 2021 to Medicare beneficiaries, the following four are the most popular options:

Best for largest networks:  Preferred Provider Organization (PPO) in California

  • Each plan includes a network of preferred medical providers, including a network hospital and specialists.
  • You can visit a hospital or other providers outside your network, but it will likely cost you more.
  • Most PPO plans include prescription drug coverage.
  • Most PPO Medicare Advantage plans in California allow you to see network specialists without a referral.
  • These are often considered the best Medicare Advantage plans for members who travel or live in multiple locations throughout the,e year, as their network restrictions are usually less cumbersome.
  • Your insurance company may add unique benefits beyond the standard Medicare Part A and B requirements, but your premium may increase.

Best for lower co-pays: Health Maintenance Organization (HMO) in California

  • Most HMO Medicare Advantage plans are restricted to a network of medical providers.
  • Depending on the rules for your chosen plan, you may receive out-of-network coverage for emergency services or select types of care.
  • HMO plans require you to choose a primary care physician or PCP.
  • Most specialist appointments require a referral.

Best for chronic health conditions: Special Needs Plans SNPs in California

  • You must meet medical criteria to sign up for Special Needs Plans. SNP plans can be the best Medicare Advantage plan in California for subscribers with chronic health conditions.
  • Special Needs Plans may include added benefits needed by patients diagnosed with chronic or institutional conditions.
  • Most Special Needs Plans will require each beneficiary to see in-network except for emergency services.
  • Many applicants qualified for SNPs are dual-eligible, so they receive Medicaid or similar state benefits in addition to Original Medicare.

Do Medicare Advantage Plans in California Cover Prescription Drugs?

Most Medicare Advantage plans in California will include prescription drug coverage, so you may not need to sign up for a separate Medicare Part D Prescription Drug Plan. Policies without Medicare Advantage Prescription Drug plans are often referred to as MA plans and are often the plans offering the $0 premium. Plans with drug coverage are referred to as Medicare Advantage Prescription Drug Plans MAPDS.

Enrollment in Preferred Provider Organization PPO plans or Health Maintenance Organization HMO plans will disqualify you from Medicare Part D enrollment, so select your Medicare Advantage plan with care. You can enroll in Medicare Part D, and Private Fee-for-Service PFFS plans simultaneously.

The federal government regulates Medicare Advantage plans. However, each insurance company can determine the benefits beyond the guaranteed coverage of Medicare Part A and Part B. Some of the differences that you may want to compare include the following:

  • Prescription Drug Tiers
  • Copayments
  • Deductibles
  • coinsurance
  • Coverage restrictions

There is no formulary way to determine rates, but you can expect to pay more for MAPD policies with the best prescription coverage.

Do Medicare Advantage plans in California have a network?

Many restrictions may apply to Medicare Advantage plans in California, but three limitations are most common:

  • Network Restrictions. Some Medicare Advantage plans require you to pick a doctor within a dedicated network, while others give you more freedom. PPO or PFFS policies are the least restrictive.
  • Emergency Medical Care. How your medical expenses are covered if you need emergency care while traveling depends on the terms of your policy. Urgent care and emergency services are covered by HMO and PPO policies, but it may cost more if you see out-of-network providers.
  • Moving. You must secure a new plan if you move to a new state. You will qualify for a special enrollment period.

Do Medicare Advantage Plans in California cover Silver Sneakers?

One way for insurance companies to make their Advantage policies more competitive is to add extra services like the following:

  • Silver Sneakers memberships
  • Medical Transportation
  • Over-the-counter medication allowances
  • Routine vision and dental
  • Hearing services
  • Wellness programs

Here are a few changes:

  • Starting in 2020, insurance companies that provide Medicare Advantage plans in California will be able to add some supplemental non-health-related benefits to particular beneficiaries, such as providing help with making structural changes to the home when needed. This change helps those who might need doorways widened or ramps installed for their homes.
  • The Centers for Medicare and Medicaid Services approved a 1.66% payment increase to Medicare insurers that offer Medicare Advantage plans in California for 2021.

California Medicare Resources

Signing up for Medicare Parts A and B is your first step. You may also want to read a complete description of benefits to know what Medicare covers without additional Medicare health plans.

After you are signed up for Medicare and know what is and isn't covered, such as some hospital expenses, temporary nursing home care, etc., you can talk to one of our agents. We know which companies are the best out of the 5-star rating system and can help you make the right choice for a Medicare Advantage plan in California, so give us a call for assistance today.

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