Medical Advantage Plans
Medicare Advantage Plans in California
These plans bundle together hospital insurance (Part A), medical insurance (Part B), and often prescription drug coverage (Part D) Medicare Advantage plans, required by the Centers for Medicare & Medicaid Services (CMS), must provide at least the same level of benefits as Original Medicare.
These plans typically offer lower out-of-pocket costs compared to Original Medicare. However, the availability of plans vary by county in California.
Choosing a Medicare Advantage Plan
When selecting a Medicare Advantage plan in California, consider factors such as:
- Costs
- Maximum out-of-pocket (MOOP) limits
- Whether your doctors are in the plan’s network
- Co-pays, coinsurance, and deductibles
- If prescription drug coverage (Part D) is included
- STAR ratings of the plan
Working with a licensed insurance agent can help you navigate these details and find the right plan for your needs.
Types of Medicare Advantage Plans
Common types of Medicare Advantage plans include:
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Health Maintenance Organization – Point of Service (HMO-POS) Plans
- Special Needs Plans (SNP) for those eligible for both Medicare and Medicaid
In addition, some less common plans may be available, such as:
- Medicare Medical Savings Account (MSA) Plans
- Private Fee-for-Service (PFFS) Plans
- Institutional Special Needs Plans (I-SNP)
- Chronic Condition Special Needs Plans (C-SNP)
There are two main categories of Medicare Advantage plans: Medicare Advantage Prescription Drug (MAPD) plans, which include Part D drug coverage, and Medicare Advantage Only (MA) plans, which do not.
Medicare Advantage STAR Ratings
CMS uses a 5-star rating system to evaluate Medicare Advantage and Part D plans based on factors such as member satisfaction, customer service, and health outcomes. You can use these ratings to review plans. If a plan consistently receives low ratings, you will be notified and may want to consider other options.
You can check a plan’s star rating using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE.
Prescription Drug Coverage (Part D)
If you need prescription drug coverage, Medicare Advantage plans with Part D (MAPD) are an option. However, if you prefer Original Medicare or have other forms of drug coverage, you may need a standalone Part D plan.
Each Part D plan has a formulary—a list of covered drugs—that can vary by plan. The cost of your prescriptions will depend on which tier your drug falls under in the formulary. Lower-tier drugs typically have lower costs.
Enrollment Periods
You can enroll in or make changes to your Medicare Advantage plan during specific periods, including:
- Initial Enrollment Period (IEP): When you first become eligible for Medicare
- Annual Enrollment Period (AEP): October 15th to December 7th
- Open Enrollment Period (OEP): January 1st to March 31st
There are also Special Enrollment Periods (SEP) for certain life events, such as moving or losing employer-based coverage.
Medicare Advantage Eligibility and Costs
To enroll in a Medicare Advantage plan, you must:
- Be enrolled in Medicare Parts A and B
- Live in the plan’s service area
Medicare Advantage plans can offer lower out of pocket costs, but you are still required to pay your Medicare Part B premium.
Work with a Licensed Insurance Agent
Medicare can be complex, and your individual needs are important when selecting a plan. A licensed Insurance Agent can guide you through your options and help you choose the right Medicare Advantage plan that suits your needs in California.
- Be enrolled in Medicare Parts A and B
- Live in the plan’s service area
Medicare Advantage plans can offer lower out of pocket costs, but you are still required to pay your Medicare Part B premium.
Speak with a Local independent Insurance agent specializing in Medicare
Medicare Advantage Plans in California
Medicare Advantage plans, offered by private insurance companies, replace Original Medicare (Part A and Part B). These plans bundle together hospital insurance (Part A), medical insurance (Part B), and often prescription drug coverage (Part D), along with extra benefits like dental, vision, and hearing coverage. Medicare Advantage plans, required by the Centers for Medicare & Medicaid Services (CMS), must provide at least the same level of benefits as Original Medicare.
Most Medicare Advantage plans include extra services like fitness memberships, transportation, and meal plans, which are not available with Original Medicare. These plans typically offer lower out-of-pocket costs compared to Original Medicare. However, the availability of plans and specific benefits vary by county in California.
Choosing a Medicare Advantage Plan
When selecting a Medicare Advantage plan in California, consider factors such as:
- Premiums
- Supplemental benefits (e.g., dental, vision)
- Maximum out-of-pocket (MOOP) limits
- Whether your doctors are in the plan’s network
- Co-pays, coinsurance, and deductibles
- If prescription drug coverage (Part D) is included
- STAR ratings of the plan
Working with a licensed Medicare advisor can help you navigate these details and find the right plan for your needs.
Types of Medicare Advantage Plans
Common types of Medicare Advantage plans include:
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Health Maintenance Organization – Point of Service (HMO-POS) Plans
- Special Needs Plans (SNP) for those eligible for both Medicare and Medicaid
In addition, some less common plans may be available, such as:
- Medicare Medical Savings Account (MSA) Plans
- Private Fee-for-Service (PFFS) Plans
- Institutional Special Needs Plans (I-SNP)
- Chronic Condition Special Needs Plans (C-SNP)
There are two main categories of Medicare Advantage plans: Medicare Advantage Prescription Drug (MAPD) plans, which include Part D drug coverage, and Medicare Advantage Only (MA) plans, which do not.
Medicare Advantage STAR Ratings
CMS uses a 5-star rating system to evaluate Medicare Advantage and Part D plans based on factors such as member satisfaction, customer service, and health outcomes. You can use these ratings to compare plans. If a plan consistently receives low ratings, you will be notified and may want to consider other options.
You can check a plan’s star rating using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE.
Prescription Drug Coverage (Part D)
If you need prescription drug coverage, Medicare Advantage plans with Part D (MAPD) are an option. However, if you prefer Original Medicare or have other forms of drug coverage, you may need a standalone Part D plan.
Each Part D plan has a formulary—a list of covered drugs—that can vary by plan. The cost of your prescriptions will depend on which tier your drug falls under in the formulary. Lower-tier drugs typically have lower costs.
Enrollment Periods
You can enroll in or make changes to your Medicare Advantage plan during specific periods, including:
- Initial Enrollment Period (IEP): When you first become eligible for Medicare
- Annual Enrollment Period (AEP): October 15th to December 7th
- Open Enrollment Period (OEP): January 1st to March 31st
There are also Special Enrollment Periods (SEP) for certain life events, such as moving or losing employer-based coverage.
Medicare Advantage Eligibility and Costs
To enroll in a Medicare Advantage plan, you must:
- Be enrolled in Medicare Parts A and B
- Live in the plan’s service area
Medicare Advantage plans can offer low or even $0 premiums, but you are still required to pay your Medicare Part B premium.
Work with a Medicare Advisor
Medicare can be complex, and your individual needs are important when selecting a plan. A licensed Medicare advisor can guide you through your options and help you choose the right Medicare Advantage plan in California.
- Be enrolled in Medicare Parts A and B
- Live in the plan’s service area
Medicare Advantage plans can offer low or even $0 premiums, but you are still required to pay your Medicare Part B premium.
Speak with a Local independent Insurance agent specializing in Medicare
Client Testimonials
What Our Clients Are Saying
Gary was incredibly helpful and knowledgeable. He made the process of choosing a Medicare plan easy and stress-free.
Phillip S.

Gaspar guided me through the options and helped me find a plan that fits my needs perfectly.
Linda M.

I highly recommend Gary for his dedication and expertise. He’s always available to answer my questions.
Cathy W.

Request a Review
Ready to Find Your Medicare Plan?
Fill Out the form to get started or contact us directly for a free review with a licensed insurance agent