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Medicare is a government-run health insurance program covering a wide range of medical expenses. The US Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) oversees the program’s administration (HHS).

Medicare covers 64 million individuals nationwide, with over 10% of those residing in California. The number of Californians covered by Medicare will reach about 6.5 million by October 2021.

In most cases, Medicare coverage is automatically activated when an individual reaches the age of 65. In addition, a person is eligible for Medicare if they have received disability benefits for at least 24 months.

Roughly 14% of Medicare enrollees in the United States qualify for disability benefits. However, just 10% of Medicare members in California are registered due to a qualifying disability or chronic illness.

With healthcare expenses rising every year, you must find an insurance plan that doesn’t cost you a fortune but also fulfills all your needs. Find out more on different Medicare plans in California and learn why you need the services of a licensed Medicare insurance agent.

An elderly couple

Medicare Options in California

Original Medicare

This is the traditional Medicare that is regulated by federal law. Part A and B belong within the Original Medicare category. Part A deals with health care services in a hospital. This covers hospital inpatient treatment, hospice care, certain specialized nursing facilities, and some home healthcare.

Part B covers medical insurance. This plan covers everything from outpatient care to in-home care and durable medical equipment. It also includes certain preventive care, such as vaccines and screenings, to maintain your health and prevent illnesses from getting worse.

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Medicare Advantage Plans in California

Though California Medicare Supplement plans offer the most extensive coverage; beneficiaries can also go for Medicare Advantage plans in California. Medicare Advantage plans are offered by private organizations that contract with Medicare. The best copays are only available if you agree to use the plan’s network of physicians and hospitals.

California Medicare Advantage plans may be less expensive than Medicare Supplements when it comes to premiums. However, you will incur copays along the way. For example, an appointment with your primary care physician (PCP) can cost you $20, while a specialist might cost you $60 or more.

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An elderly couple talking to a Medicare insurance agent

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended network of providers, but you can also choose doctors or hospitals outside the network for a higher price.

  • You don’t need to have a PCP or referrals for specialists.
  • Most plans provide drug coverage.
  • Drug coverage cannot be purchased separately.
  • Out-of-network charges and higher premiums.

Private Fee-For-Service (PFFS)

PCPs and specialist referrals aren’t necessary under PFFS programs:

  • You can consult any Medicare-approved doctor or healthcare facility, provided that they agree to the plan’s
  • Drug coverage may be included, or you can purchase a separate drug plan.
  • You’ll pay more if you go with a provider who doesn’t agree with the rules of your insurance plan.

Special Needs Plan (SNP)

SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:

  • You require a PCP and recommendations for specialists.
  • Plans always include prescription coverage.
  • SNPs are open to everyone who meets the eligibility criteria at any point in time.
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Comparing Medicare Advantage Plans in California

Medicare Advantage enrollment is on the rise in California – keeping in line with the nationwide trend. 40% of Medicare beneficiaries in California were enrolled in private Medicare Advantage plans as of 2018 – which is huge considering the 34% nationwide. This figure also rose to 48% in 2021.

When weighing your Medicare insurance options, the following factors are important to consider:

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Medicare Eligibility in California

Patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), can also enroll for Medicare at any point in their lives.

Medicare Enrollment in California

Medicare will register you automatically if you have received at least four Social Security or Railroad Retirement Board payments before your 65thbirthday. Otherwise, you can reach out to your local Social Security Office or apply online. We recommend not mailing your application as that is a much slower process.

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Why Should You Choose Medicare Hope Insurance Agents?

At Integrity Now Insurance Brokers, our Medicare Insurance Agents are accredited annually by America’s Health Insurance Plan (AHIP). Your Medicare Insurance needs are in good hands with us. We work with the elderly, youth with disabilities, and others who need help taking care of their healthcare expenses.

Every year, new Medicare insurance providers and policies enter the market. Existing plans can also experience adjustments and updates. We keep tabs on all of these changes for you, so you don’t have to.

A Medicare insurance agent in California will review your healthcare needs and weigh all your options. This includes figuring out if a Medicare Supplement Plan or a Medicare Advantage Plan is best for you.

With our guidance, you can compare quotes and find the best Medicare insurance plan for your needs. We have all the information you need to get started on debt-free and stress-free living.

Call us to speak with one of our representatives and get started today!

: A Medicare insurance agent

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