What is health insurance and am I eligible?
Medicare is a federal health insurance plan that consists of four main parts: Parts A, B, C, and D. Parts A and B together are called “primitive health insurance” provided by the government.
U.S. citizens 65 years of age and older or who have been legal residents for at least 5 years and who are 65 years of age or older and who have worked in a Medicare-covered job for at least 10 years (or 40 quarters) are eligible for Medicare coverage. If Someone who meets the criteria for certain disabilities may also be eligible for Medicare under age 65. Different Medicare plans may have different requirements.
Click the link to see if you are eligible for Medicare and to calculate your premium.
Medicare Part A Eligible Hospital Insurance:
- You are at least 64 years and 9 months old, or; you are under the age of 65 but have a disability or disease; or you have end-stage renal disease (ESRD).
Medicare Part B Eligible Health Insurance:
- You are at least 64 years and 9 months old, or; you are under 65 years old but have a disability or condition; or you have end-stage renal disease (ESRD).
Medicare Part C Eligibility (Medicare Advantage Plans – Offered in California):
- You are entitled to Part A, and; you are entitled to Part B, and “you do not have end-stage renal disease (ESRD), unless you have an exception, and; you live in the plan’s service area.
Medicare is a federal health insurance plan with very specific enrollment rules that we’ll cover in this article. Go here to read more about the four parts of Medicare.
Like other states, California has a number of private companies offering health care plans that partner with Medicare to provide health coverage to eligible individuals. We will go into details in this article.
California Medicare Eligibility Guide
There are four ways to qualify for Medicare in California:
You are over 65 You have End Stage Renal Disease (ESRD) You have Lou Gehrig Disease (ALS) You are currently receiving Social Security Disability Insurance (SSDI) for more than 25 months.
Once you confirm that you meet the eligibility requirements, you can start purchasing various health plan solutions.
Medicare Health Plans in California
While there are hundreds of health insurance plans to choose from in California, there may be only a few that are available to you and make sense for your needs. Remember, Original Medicare (a government-sponsored health insurance plan) is not the same as the privately owned California Medicare Advantage and Medicare Supplement plans.
Original Medicare consists of Parts A and B, which you will start with first when you are eligible for Medicare. You can read more about the 4 parts of Medicare here.
Once you have Part A and Part B, most people will decide between enrolling in the options below.
- Medicare Advantage plans and Medicare Part D prescription drug coverage. Medicare Supplement and Medicare Part D prescription drug coverage. Standalone Prescription Drug Coverage (Part d) plan.
California’s Medicare Advantage Program
California’s Medicare Advantage plans are a great option for those who want additional health insurance benefits than those offered strictly through Original Medicare.
Contrary to what you may have heard, the Medicare benefit plan still requires you to have all Part A and Part B benefits, but there may be more!
Additional health insurance benefits may include:
- Fitness ProgramMeal DeliveryDental VisionHearingNon-Emergency Transportation
Need help making your California Medicare enrollment decision? We recommend that you list the health care benefits you need before you start buying Medicare coverage from any insurance company. Also, list the doctors and pharmacies you would like to see and the prescriptions you are currently taking. Make sure the plan you choose meets all your needs.
Medicare Advantage Plan Enrollment Details
Enroll in a Medicare Advantage plan between October 7 and December 15 each year. This is called the annual election period, and is the time period when most Medicare Advantage plan enrollments occur.
If you just turned 65 and are eligible for Medicare, your initial enrollment date will begin on the first day of your birth month. For example, if your birthday is May 15, your Medicare effective date will be May 1.
Medicare Supplemental Plans in California
If Medicare Advantage is not right for you, you may want to consider a Medicare supplement.These plans are often called “Medigap” because they close the gap between Medicare coverage and your out-of-pocket costs.Medigap plans generally don’t include all the extra benefits that a Medicare Advantage plan can provide. Instead, Medigap plans can cover your Part A and Part B premiums, deductibles, copays, and coinsurance.
How Much Does California Medicare Cost?
If you stick to the basics (Parts A and B), your costs will be standardized.
Most people will have a premium-free Part A (unless you don’t pay Medicare taxes throughout your life). Standard Part B premiums for 2021 are $148.50 per month and the standard deductible is $203 per year.
Most people won’t pay less or more, but these numbers can be adjusted based on your income.
If you are in a Part D plan, your costs will vary slightly depending on the plan you choose. However, the standard deductible for 2021 is $445. Premiums for prescription drug plans can be as low as $13 per month or as high as $80.
If you are enrolled in Medicare Advantage or Medicare Supplement, you will get different premiums.
Some $0 premium Medicare Advantage plans may be available in your area. Keep in mind that if you don’t pay your premiums, your deductibles and copays may be higher.
Finally, the cost of Medicare coverage can vary depending on where you live. For example, the premiums for the Medicare Advantage plan in Los Angeles may be completely different from the premiums in Sacramento.
Medicare Part D Prescription Drug Discount Program
Did you know that California Medicare recipients can get Medicaid-level drug pricing?
No matter what prescription drug coverage you have, you can get a big discount as long as you have a Medicare card that proves you have Medicare coverage.
When you pick up your prescription, show your Medicare card to the pharmacy and ask for the Medi-Cal reimbursement price. If the Medi-Cal price is lower, they can give you that price instead.
Note that if you have a great Part D or Medicare Advantage plan, it may actually be cheaper to use a Medicare plan than a Medi-Cal discount.
Always make sure the price is actually lower before going this route. Also, know that this discounted rate is only available at pharmacies that accept Medi-Cal insurance, so your favorite pharmacy may not be participating in the program.
Can I get Medicare and Medicaid in California?
Medi-Cal is someone who receives Medicaid benefits in California.
If you are eligible for Medicare and meet California Medicaid (Medi-Cal) income requirements, you may be eligible for a program that benefits from both programs, called a Dual Special Needs Program (DSNP).
DSNP usually covers most, if not all, of your health care costs.
How do I enroll and qualify for Medicare?
Call Social Security at 800.772.1213 (TTY 800.325.0778)
Visit your local Social Security office in Alameda, Contra Costa, Placer, Sacramento, Santa Clara and Yolo counties.
- Alameda County Social Security Office Location Contra Costa County Social Security Office Location Placer County Social Security Office Location Sacramento County Social Security Office Location Santa Clara County Social Security Office Location Yolo County Social Security Office Location
Download the Medicare application you need and mail or take it to your local Social Security office.
Medicare can be a complicated plan that can be difficult to understand, and Nivano is committed to making it easier for you to navigate so that you can make the best decisions for you.
If you have specific questions, please feel free to call the Nivano Medicare hotline at 866-674-3959 and our state-licensed agents are ready to answer all your questions.