California Medicare Plans
California Medicare plans are run and funded by the federal government, but Medicare beneficiaries can often benefit from a Medicare Supplement or Advantage plan.
California residents already enrolled in a Medicare Supplement plan are allowed to switch to another supplement of the same type or one with lesser benefits and not be denied because of their health.
California Medicare Plans Open Enrollment
Medicare beneficiaries in California are eligible for Medicare at age 65, just like the other 50 states.
Initial enrollment begins three months before your birth month and lasts three months after. This is also the time you can apply for Medicare Supplements. While you can enroll in a supplement at any time, initial enrollment is the best time to do so because you cannot be turned down due to health conditions considering you won’t have to answer health questions on your application. If you miss this window, you’ll likely have to answer health questions to apply, which means you could be turned down by other California Medicare supplement plans. However, the state of California has a unique feature that allows you to have a second shot at applying without health questions.
California’s Birthday Rule
Medicare beneficiaries in California are allowed to enroll in a Medigap plan 30 days leading up to their birthday and 30 days directly after their birthday. This doesn’t apply to Medicare Advantage plans. You can enroll in a supplement plan at any time, but your health will be evaluated outside of initial enrollment and the birthday rule window.
During this period of time, you cannot be denied for health conditions. However, you must already be enrolled in a California Medicare supplement in order to take advantage of the birthday rule. You can keep the same plan type or choose one of the California Medigap plans with lesser benefits.
California Medicare beneficiaries have an annual chance to shop their rates regardless of health.
Outside of your annual birthday open enrollment, you can still apply for a California Medigap policy at any time, but you’ll have to go through the normal health underwriting process.
California’s Medicare Advantage Plans
While California Medicare supplements provide the most comprehensive coverage, another option beneficiaries can consider are California Medicare Advantage plans. Also known as Part C plans, Medicare Advantage is a private Medicare plan that provides all Original Medicare benefits but also include extra benefits like dental, prescription drugs, and vision coverage. You agree to use the plan’s network of doctors and hospitals for your care in order to get the best copays.
Medicare Part C Plans are available in only 40 of the 58 counties in California. Availability of plans range from only one plan to 70.
California Medicare Advantage plans may often have lower premiums than Medicare Supplements. However, you will pay copays as you go. There are usually copays for things like hospital stays, lab work, diagnostic imaging, ambulance rides, durable medical equipment, and surgeries. It’s important to determine if your doctor is in the network before you enroll.
It’s important that you choose the right plan, because you can only enroll or dis-enroll from California Medicare Advantage plans at certain times of the year.
California’s Medicare Part D
While Original Medicare and Medicare Supplement plans don’t offer coverage for prescription drugs, there is an option to enroll in Medicare Part D. In the state of California, there are close to 30 Part D plans available. If you don’t want to pay out-of-pocket for your prescriptions, a Medicare Advantage or a standalone Part D plan might be a great option for you.
California Medigap Plans
Medicare Supplements in California cover some or all of the deductibles and coinsurance left over by Original Medicare. California Medigap plans help fill the gaps between what Medicare pays and what you owe.
There are 10 plans lettered A through N that offer standardized coverage. Essentially, all plans with the same letter have to offer the same coverage with the only difference being price. This makes it important to shop around your coverage.
California Medicare Supplements for People Under Age 65
Some beneficiaries qualify for Medicare due to disability even before the age of 65. Those that qualify have the right to purchase California Medigap plans during the first 6 months of their Part B coverage. However, if you’ve been diagnosed with End State Renal Disease, there is a chance you can be denied coverage.
Medicare Advantage for California Residents Under the Age of 65 with Disabilities
While Medicare is generally reserved for those turning 65, there are cases in which someone may be eligible for Medicare under the age of 65. This includes individuals with disabilities who have received Social Security Disability Income for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).
It is important to note that there is a five-month waiting period after a beneficiary is determined to be disabled before they can begin to collect Social Security Disability Income. People who meet all the criteria for Social Security Disability Income are generally automatically enrolled in Medicare Part A and Part B. For the people who meet the standards, but do not qualify for Social Security Income, have an option to purchase Medicare by paying a Part A premium monthly as well as a monthly Part B premium.
An exception to the 5-month waiting people does apply for those people with ESRD and ALS. These individuals do not have to collect benefits for 24 months in order to become eligible for Medicare.
The requirements for Medicare eligibility for people with ESRD and ALS are:
- ESRD – Generally 3 months after a course of regular dialysis begins or after a kidney transplant
- ALS – Immediately upon collecting Social Security Disability benefits
Regrettably, those with disabilities often have lower incomes, require more health care, and find it more difficult to pay for and obtain care compared to Medicare beneficiaries over 65 years of age. Take our Medicare quiz now to see if you qualify for incredible Medicare benefits, even if you are under the age of 65.
Every state is different, and so obtaining Medicare benefits in California can be complicated or confusing. If you are disabled or under the age of 65 wondering if you qualify, it is best to contact us directly to see if you are eligible.
What Medicare benefits am I eligible for under the age of 65 in California?
At 100 Insure, we can help you discover benefits you might be eligible for including:
- Premiums starting at $0 per month
- Coverage for copays and deductibles
- Prescription drugs
- And transportation to the doctor and pharmacy
That’s right. Our company has helped qualified people under the age of 65 in California receive benefits like:
- Massage services
- Meals after a hospital
- Food for their service dog
- A gym membership
- Money for vitamins and groceries
- Home improvements
- In home care & aides
- And pest control services
Contact us today to see if you qualify.
Medicare Coverage for Working People in California with Disabilities
Medicare eligibility for working people with disabilities falls into three distinct time frames.
- Trial work period – extends 9 months after a disabled individual obtains a job
- Second period – This period is for 93 months after the end of the trial work period.
- Third period – An indefinite period following those 93 months.
Keep in mind that Medicare eligibility during each of these periods applies only while the individual continues to meet the medical standard for being considered disabled under Social Security rules.