Medicare Advantage Plans in California
Choosing the right Medicare Advantage plan in California is an important step toward protecting your health, managing your healthcare costs, and getting the coverage you need to make the most of the years ahead. While Original Medicare (Parts A and B) covers your basic health care needs, Medicare Advantage (Part C) plans offer added benefits, coverage options, and support designed for California's diverse communities. With the right guidance, you can confidently select a plan that fits your health needs, lifestyle, and budget.
Medicare Advantage (Part C) Plans: What’s Included?
Medicare Advantage (Part C) plans include Original Medicare (Part A and B), plus additional benefits for seniors who need more than what Original Medicare offers. For seniors in California, Original Medicare includes:
- Part A (Hospital insurance): Inpatient care in hospitals, care at skilled nursing facilities (SNF), hospice care, and some home health care
- Part B (Medical insurance): Doctor services, preventive care, screenings, and outpatient care
Additional benefits with Medicare Advantage (Part C) typically include:
- Prescription drug coverage
- Dental, vision, and hearing services
- Enhanced wellness benefits, such as gym memberships, transportation for health-related appointments, flexible spending allowances, and more
The Benefits of a Medicare Advantage Plan in California
Medicare Advantage plans in California offer services and benefits that cater to the specific health care needs of seniors living in California. Examples of these benefits include:
Transportation Services
California's large geography means many Medicare Advantage plans may include:
- Rideshare services for medical appointments
- Non-emergency medical transportation (NEMT)
Wellness and Lifestyle Benefits
Your health goes beyond doctor visits. Many Medicare Advantage plans in California recognize this by offering benefits that help you stay active and feel your best:
- Gym memberships at local fitness centers
- Flexible spending allowances for over-the-counter (OTC) medicines and health items
- Coverage for alternative medicine and treatments such as acupuncture or chiropractic services
Access to Nutrition Services and Healthy Meals
Good nutrition is the foundation of healthy living. Many Medicare Advantage plans in California include:
- Nutrition counseling from registered dietitians
- Spending allowances for groceries
- Healthy, home-delivered meals
Medicare Advantage Options in California
California offers diverse Medicare Advantage plans designed to fit different lifestyles and health needs. Finding the right match starts with understanding your options:
- Health Maintenance Organization (HMO): With a Medicare HMO plan, you have a network of doctors and specialists who work together to provide coordinated, managed care. HMO plans typically offer lower out-of-pocket costs compared to a PPO (Preferred Provider Organization) plan, but you are limited to in-network providers and will need to get referrals from your assigned primary care provider (PCP) to see specialists.
- Preferred Provider Organization (PPO): Medicare PPO plans provide more options and flexibility when selecting your doctors and specialists. You are not required to select a PCP, and you do not need a referral from your PCP to see a specialist.
- Private Fee-For-Service (PFFS): Medicare PFFS plans allow you to see any Medicare-approved doctor or hospital that accepts the plan's payment terms and agrees to treat you. Unlike HMOs, you don't need to choose a primary care provider (PCP) or get referrals for specialists. The plan determines how much it will pay providers and how much you'll pay for services. Not all providers accept PFFS plans, so it's important to confirm acceptance before receiving care.
- Point-of-Service (POS): Medicare POS plans combine features of HMO and PPO plans. Like an HMO, you'll choose a primary care provider (PCP) who coordinates your care and provides referrals to specialists. However, like a PPO, you have the option to see out-of-network providers, typically at a higher cost.
- Special Needs Plans (SNPs): Medicare SNPs offer specialized health care coverage for those with qualifying chronic conditions or those who are eligible for both Medicare and Medicaid. Medicare Advantage SNPs are ideal for those who can't get the coverage they need through Medicare Part A and B because of their unique health care needs. The two most common types of SNPs include:
- Chronic Condition Special Needs Plan (C-SNP): C-SNPs are for Medicare beneficiaries with chronic or severe medical conditions, such as cardiovascular disorders, diabetes, lung disorders, end-stage renal disease (ESRD), mental health conditions, and more. This type of plan helps coordinate care and gives extra coverage for specific health conditions that are not part of Original Medicare, including access to specialists or condition-specific health benefits.
- Dual Eligible Special Needs Plan (D-SNP): D-SNPs are for Medicare beneficiaries who are eligible for both Medicare and Medicaid. In California, Medi-Cal is the state’s Medicaid program.
When to Enroll in a Medicare Advantage (Part C) Plan
You can enroll in a Medicare Advantage plan 3 months before or after your 65th birthday. You’ll also have an opportunity to enroll during Medicare’s Annual Enrollment Period, which runs from October 15 to December 7 every year. If you missed your opportunity to enroll in a Medicare Advantage plan during these two periods, then you will have to wait until the next Annual Enrollment Period.
Special Enrollment Period are available for qualifying life changes. Some of the most common events that would trigger a Special Enrollment Period would be if you move to another county or state, or if you lose coverage from your current health plan.
Frequently Asked Questions (FAQ) About Medicare Advantage Plans in California
Expand all | Collapse all
-
A Medicare eligibility begins at age 65. However, you may qualify for Medicare before you turn 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease. You must be a U.S. citizen or legal resident who has lived in the U.S. for at least five years. In California, Medi-Cal recipients may also be qualified to enroll in a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP).
-
A Medicare is the U.S. federal health insurance program for seniors who are 65 and older and those who are under 65 with certain disabilities or specific conditions. Medi-Cal is California’s Medicaid program, which provides low or no-cost health coverage for eligible low-income individuals and families in need of medical care.
Need more answers about Medicare Advantage? Visit our Frequently Asked Questions (FAQs) page for more information.
Ready to Enroll in a Medicare Advantage Plan in California?
Alignment Health Plan proudly offers Medicare Advantage plans throughout California, designed to support you in living your best life. With our 24/7 ACCESS On-Demand Concierge service, comprehensive benefits, and award-winning care, you'll have everything you need to feel confident about your health care decisions.
Ready to explore your Medicare Advantage options with Alignment Health Plan? Use our Plan Finder tool or register to attend a seminar to see which Medicare Advantage plans are available in your area. You can also call us at 1-888-293-8272 (TTY: 711) to speak with one of our experts. We are available from 8:00 a.m. to 8:00 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30.