Living in and retiring in California can have many benefits, not the least of which is an abundant choice of health insurance plans.
Senior residents of Sonoma County are increasingly looking for affordable, quality healthcare, and more adults are graying every year. In fact, it is estimated that each day, almost 10,000 Baby Boomers are celebrating their 65th birthday.
And 65 is the age at which Americans are expected to enroll in Medicare.
The good news is that, according to MedicareGuide, California ranks #4 out of all 50 states for providing the best Medicare coverage based on cost, access, and quality.
Considering Medicare – California Style
When it comes to Medicare eligibility, California is the same as all other states.
RetireGuide describes Medicare this way on their website,
“Even though it’s a federal program, Medicare coverage, costs and benefits can vary widely from state to state. Medicare covered nearly 60 million Americans in 2018, the most recent year numbers are available from the U.S. Centers for Medicare & Medicaid Services.
More than 64 percent of those people were covered by Original Medicare — Medicare Part A and Part B. It’s managed by the federal government and is the same from state to state.
But there are also Medicare Advantage plans, Medicare Part D drug plans and Medigap policies that either overlap with or replace Original Medicare for millions of people on Medicare. These are private plans sold by insurance companies.
These private plans are regulated by state insurance commissions and they differ from state to state.”
According to the Kaiser Family Foundation (KFF), the role of Medicare Advantage, the private plan alternative to traditional Medicare, has grown significantly over the last 10 years. In 2021, more than 26 million people are currently enrolled in a Medicare Advantage plan, which accounts for 42 percent of the total Medicare population.
In California, over 45 percent of those eligible are currently enrolled in a Medicare Advantage plan, and in Sonoma County, that percentage is over 50 percent.
This chart from KFF illustrates the breakdown of plan types by how members are enrolled:
According to information from Healthline.com, there were 424 Medicare Advantage plans available in California in 2021, compared to 372 plans in 2020.
Almost 98 percent of California residents with Medicare have access to buy a Medicare Advantage plan, while 92 percent have access to $0 premium plan options.
And KFF notes that,
“Medicare Advantage enrollment is highly concentrated among a small number of firms. UnitedHealthcare and Humana together account for 45 percent of all Medicare Advantage enrollees nationwide, and the BCBS affiliates (including Anthem BCBS plans) account for another 14 percent of enrollment in 2021. Four firms (CVS Health, Kaiser Permanente, Centene, and Cigna) account for another 23 percent of enrollment in 2021.”
Medicare Supplement Plans – California Options
In addition to (Original) Medicare and Medicare Advantage Plans, you can also acquire Medical Supplement Insurance, also known as Medigap, in addition to Medicare Advantage, also known as Medicare Part C.
Medicare Advantage Plans, on the other hand, are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.
Most Medicare Advantage Plans include drug coverage (Part D).
As the Medicare.gov website explains, Medigap is Medicare Supplement Insurance that helps fill ‘gaps’ in Original Medicare and is sold by private companies.
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
- Copayments
- Coinsurance
- Deductibles
In California there are a handful of insurance carriers that provide Medicare Advantage plans. At J.C. Lewis Insurance Services, there are four top carriers that we work with to write the most policies for Medicare Advantage Plans (AKA Medicare Part C.) These are UnitedHealthCare, SCAN, Western Health Advantage, and Anthem Blue Cross.
For Medicare Supplemental Insurance or Medigap policies, the top insurance carriers we work with are UnitedHealthCare, Blue Shield of California, Anthem Blue Cross, and Humana.
Medicare Eligibility In California
According to the Social Security Administration,
“Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare too, including those with disabilities and those who have permanent kidney failure.
The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.”
If you will be turning 65 soon, you should also be aware of your California Medicare eligibility.
Medicare requires that you enroll into it at least 90 days in advance of the month in which you turn age 65. In some instances, you are automatically enrolled into Medicare if you become disabled or start drawing your social security before you reach retirement age.
There is an open enrollment period when you can enroll in Medicare parts A and B. If you’re still working and not receiving benefits from Social Security or Railroad Retirement Board (RRB), but would still like to enroll in Medicare, you need to call the Social Security Administration at 1-800-772-1213.
The seven (7) month open enrollment period for Medicare begins three (3) months prior to the month you turn 65.
The period includes the month you turn 65 and ends three months after the month you turn 65. If you currently receive Social Security or RRB benefits, then you’ll receive Medicare parts A and B automatically on your 65th birthday.
If you’re disabled and have been receiving Social Security or RRB benefits for 24 months you automatically get Medicare parts A and B.
J.C. Lewis Insurance Services And Medicare
JC Lewis Insurance, located in beautiful Santa Rosa in Sonoma County, offers California health insurance plans only from leading health insurance carriers licensed to do business in California.
In addition to being expert health insurance agents and brokers, we are licensed and certified by each insurance carrier to offer coverage to individuals, families, small group employers, and to seniors for Medicare supplemental and prescription drug plans.
If you are currently working and your employer doesn’t provide health benefits, an individual or family plan may be the best option for you and your spouse.
After enrolling in Medicare, take advantage of your one-time “Welcome to Medicare” preventive visit. This comprehensive visit comes at no cost and helps you plan for a healthy future. To prepare for this visit be sure to bring your medical and immunization records, information about your family’s health history, and a list of your prescription medications.
For help in finding the right California Medicare health or prescription drug plan and finding Medicare providers in your area, give JC Lewis Insurance Services a call toll-free at 866-745-9555.
We’ll help you understand your options so you can make an informed decision
