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

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