California-medicare-plans

California Medicare Plans, Enrollment Period & More

Not surprisingly, California is the most populous state in the United States! Between the large, well-known areas of Los Angeles, San Francisco, San Diego, and more, the amount of people who move to and live in California seems to be continuously growing. Therefore, it comes as no surprise that there are also many Medicare-age residents in California trying to navigate the complex world of retirement, including Medigap and Medicare Advantage plans! If you live in one of the best states and plan to enroll in California Medicare plans, or if you are already enrolled, it is vital to understand the timelines, rules, and options available to you.

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What is the California Medicare Birthday Rule?

If you have a Medicare supplement plan in California, you can change plans once a year without medical underwriting.

When Does the Birthday Rule Apply?

The California birthday rule starts 30 days before your birthday and ends 30 days after your birthday. All changes must occur within this time period.

Who Can Use the Birthday Rule?

Anyone currently enrolled in a Medicare supplement plan can use the birthday rule. The birthday rule does not apply for those enrolled in a Medicare Advantage plan.

What are Medicare Options in California?

California provides its residents with the standard Medicare Supplement plans. You may be more familiar with the phrase “Medigap plans,” but they refer to the same thing. If you are a resident, you can choose from the following California Medicare plans: A, B, C, D, F, G, H, K, L, M, N, high-deductible Plan F, and high-deductible Plan G.

You can enroll during the year, but if you want to ensure you’ll be covered, you will want to apply during your open enrollment period. Luckily, unlike many other states, California residents are given the option to change their Medicare Supplement plan with no medical underwriting every year.

What are the Most Popular Medicare Supplement Plans in California?

While you’re deciding which Medicare supplements to apply for, you may be curious about which plans other California residents enrolled in. The following Medicare supplement plans are the most popular because they have predictable, out-of-pocket costs.

  1. Medicare Supplement Plan F
  2. Medicare Supplement Plan G
  3. Medicare Supplement Plan N

When is the Open Enrollment Period in California?

Like all the other states, at age 65, you receive eligibility to enroll in Medicare. Beginning three months before your birthday, including your birth month, and ending three months after your birthday is a period known as your Initial Enrollment Period (IEP), which is when you can first enroll in Medicare Parts A and B. If you continue to work past age 65 and delay your Medicare enrollment, you may also qualify for what is known as a Special Enrollment Period (SEP) when you retire and leave your employer’s insurance.

Whether you enroll in one of the California Medicare plans at age 65 or after retirement, this is also the prime time to enroll in a Medigap plan. You have 6-months from your Medicare Part B effective date to enroll in a Medicare Supplement plan with no medical underwriting. This means that insurance companies are required to accept you into their plans and cannot deny you based on your medical history or pre-existing conditions.

Can I Change Medicare Supplement Plans in California?

California is one of few states that gives Medicare Supplement plan enrollees the ability to change their Medigap plans once per year with no medical underwriting. This is known as the California Birthday Rule.

California Birthday Rule 

The California Birthday Rule begins 30 days before your birthday and ends 30 days after your birthday, giving you a total of sixty days around your birthday to change your Medigap plan.


california-birthday-rule

Like all good things, however, there are a few rules to remember. The first rule is that you must already be enrolled in a Medicare Supplement plan to take advantage of the Birthday Rule. In other words, people with no additional coverage or Medicare Advantage plans do not qualify. The second rule is that you must change your plan to one of equal or lesser coverage. Essentially you can change from one Plan G to another Plan G or down to a Plan N, but you cannot use this rule to change from a Plan N to a Plan G.

Changing MediGap Plans without California Birthday Rule

Outside of using the California Birthday Rule, changing Medicare Supplement plans in California follows the same guidelines as most other states. If six months have passed since your open-enrollment period for Medicare Part B ended, you will need medical underwriting to apply for or change your Medicare Supplement plan. Insurance carriers will look over your medical history, assessing health-related factors, to determine if you should be approved or denied coverage. Because these carriers can deny coverage based on pre-existing conditions, it’s suggested that you enroll in a Medigap plan during your open-enrollment period to ensure you are accepted before your health declines.

Medigap Plan F in California

Medigap Supplement Plan F was a top-rated plan for those receiving Medicare eligibility prior to January 2020 because this plan covers all items that would typically have been paid out-of-pocket from Medicare Parts A and B, including deductibles and coinsurance.

Unfortunately, new Medicare enrollees who become eligible after January 1st, 2020, will not be able to apply for Medicare Plan F. If you are currently enrolled in Plan F, you can keep your coverage.

Medigap Plan G in California

Medigap Supplement Plan G is quickly becoming the most popular Medicare plan since seniors can no longer apply for Plan F. Plan G will cover almost all expenses except the Part B annual deductible. Once you meet the Part B deductible, insurance benefits will begin to pay out. The monthly premium for Plan G may be higher than the other supplemental plans, but the premium is still highly affordable for the full coverage that it offers. This plan is often boasted as the best Medigap plan for new enrollees.

Plan G can be a very good choice in California. It's a great plan but we may also be able to find better value. Give us a call and we will look through all options.
Keith Armbrecht
Medicare on Video

Medigap Plan N in California

Medigap Supplement Plan N is an excellent alternative to Medigap Plan G because it still offers comprehensive coverage but at a slightly cheaper rate. You will still be responsible for Medicare Part B’s annual deductible, and you will have to make copayments up to $20 on office visits and $50 on ER visits. If your estimated medical expenses are more than the annual premiums for Plan N, this Medicare Supplement plan may be the ideal option for you.

What is the Cost of a Medicare Supplement Plan in California?

There is no set price for the cost of Medicare Supplement plans. Insurance companies base your monthly premiums on three core factors: your age, gender, and location. In some cases, the premium costs can be based on other factors, such as tobacco use. Since the price can vary, it’s important to get a quote catered towards your specific demographic information.

Medicare Plans in California for Those Under 65

If you have a disability before reaching 65, you have the right to buy a supplement plan within the first six months of being covered by Part B. The only exception is if you’ve been diagnosed with ESRD or kidney failure. Even though you can buy a plan, carriers can charge a higher premium, so these rates may often be higher. If they’re too expensive, consider an affordable Medicare Advantage Plan.

Once you finally reach the age of 65, you will become eligible for more California Medicare plans, and you will not have to answer any health questions. During this period, acceptance is guaranteed.

Medicare Advantage Plans in California

Medicare Advantage plans are also known as Medicare Part C. Unlike other Medicare Supplement plans, you will need to use health care providers in the plan’s network and service area. MAs set a limit on the amount of out-of-pocket expenses you have to pay each year to protect you from unexpected costs. Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs).

Medicare and Medicaid in California

Medicare and Medicaid are two separate programs, and in California, you can qualify for both programs. The requirements for qualification vary based on the program; Medicaid has income requirements, while Medicare has specific age requirements. If you’re interested in Medicaid, you must meet California’s state income guidelines. If you’re interested in enrolling in Medicare, you must be over the age of 65 or receiving Social Security Disability Insurance for at least 24 months before applying for Medicare.

If you have any questions about the California Medicare plans, including the Medicare Advantage plans and the Medicare supplement plans, and which ones are best for you, explore Medicare On Video or reach out to our team of agents today.

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