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Medicare in California

Finding the right Medicare plan in California takes time and consideration. With the right assistance, you can navigate Medicare Parts A, B, C, and D to find the right coverage. Plans vary by cost, benefits, and added services, so working with qualified help is a great way to choose the best option.

While Medicare Parts A and B cover basic needs for patients, there are added benefits to Medicare Advantage plans in California. Let’s explore these plans and what they offer.


Medicare Advantage Plans (Medicare Part C) In California

Medicare Advantage (Part C) refers to plans that include the same benefits as Medicare Parts A and B but with additional coverage. For patients that need more than what Original Medicare can provide, Medicare Part C is a great option.

Medicare Advantage includes the following benefits for enrolled members:

  • Prescription Coverage - Most Part C plans include a prescription drug coverage plan, which can greatly benefit those who regularly take medicine.
  • Out-of-Pocket Expenses - Depending on your exact plan, your Medicare Part C plan may cap out-of-pocket costs. This benefit helps give patients peace of mind regarding unexpected illness or injury. Once they reach their cap, they pay nothing for the rest of the year.
  • More Benefits - Medicare Part C coverage is expansive, providing more benefits than Original Medicare plans.

Types of Medicare Advantage Plans in California

To help determine if a Part C plan is right for you, here is a brief look at different types of Part C plans:

  • HMOs - A Medicare Health Maintenance Organization (HMO) plan allows you to choose a primary care physician who you’ll see for regular exams and checkups. Working with the same primary care physician also means they can help you find specialists when needed.
  • PPOs - Preferred Provider Organization plans (PPOs) do not require you to choose one primary care physician. Instead, you can see any doctor or specialist you wish to. The services may cost more if you visit doctors outside of your plan.
  • SNPs - Special Needs Plans (SNPs) are Medicare Advantage plans for those living with certain medical disabilities or low-income individuals. For example, a Chronic Condition SNP covers those with conditions like diabetes and lung disorder.
    • C-SNPs - Chronic Condition Special Needs (C-SNP) plans meet the needs of those with one or more chronic conditions, such as heart disease or asthma. These plans offer tailored benefits like transportation assistance and personalized health plans.
    • D-SNPs - Dual Eligible Special Needs (D-SNP) plans meet the needs of dually eligible beneficiaries, meaning individuals who are entitled to both Medicare and Medicaid.

When to Enroll in a Medicare Advantage Plan

If a Medicare Advantage plan is right for you, the first step is to enroll. Note that you cannot enroll in Medicare C plans at anytime; there are specific periods when enrollment is open. The Medicare Annual Enrollment period is every year from October 15 to December 7. You can also enroll for Medicare Advantage 3 months before or after your 65th birthday. Remember that if you do not sign up for Medicare in the three months before or after your birthday (the initial enrollment period), you will need to wait for the annual enrollment period.

Some patients have Medicare eligibility for Special Enrollment Periods (SEPs), which are based on personal circumstances. For example, if you have experienced a life change that permits you to enroll in Medicare Advantage, you may be eligible for a special period. Other factors qualifying you for SEPs include losing employee coverage, moving into or out of a nursing home, or becoming eligible for Medicaid. The dates for SEPs vary based on circumstances.


What Do Medicare Advantage Plans Cover?

Part C plans cover Parts A and B, and as mentioned, some plans include prescription drug coverage as well (Part D).

Part A Medicare generally covers inpatient hospital care, home health care, nursing home care, and other inpatient needs. Part B covers doctors’ services, preventative care, screenings, medical tests, and other outpatient care. So, Medicare Advantage covers both of these areas with added benefits. For example, some Medicare C plans include:

  • Fitness Center Memberships
  • Vision Care
  • Dental Care
  • Hearing Care

This routine health coverage may benefit patients who want to monitor these aspects of their health continuously while limiting out-of-pocket costs.


Benefits of Alignment Medicare Advantage Plans

Alignment Health Plan is a team of California health advocates delivering high-quality care and service to Medicare Advantage members. We proudly offer a variety of Advantage Plans designed for the beneficiaries in the counties we serve. Some benefits of our Advantage plans include:

  • More Services - Part C plans give patients more services and flexibility when accessing healthcare. For example, Medicare Advantage plans may include non-medical supplemental benefits such as transportation to medical appointments, meal delivery, assistance with bathing and cooking, and more.
  • Low or No Premiums - Many Part C plans have low premiums, while others have none. Depending on the plan selected, you can receive additional benefits at no extra cost.
  • Carefully Selected Providers - Many Part C plans, particularly HMOs, work with a care team led by your primary care physician, including other nurses, physicians, and physician assistants that provide coordinated care.
  • Out-of-Pocket Cap - With Medicare Advantage, you will benefit from an out-of-pocket limit that caps expenses once you have hit the limit.
  • Lower Copayments and Deductibles - If the Advantage plan you choose has deductibles and copays, you will have freedom in selecting the right plan for you. You can work with a health insurance broker who represents you and can provide you with information about all the plans available to you.

If you are interested in Alignment Medicare Advantage plans, contact us today to get started.


Frequently Asked Questions

What is the difference between Medicare and Medi-Cal?

Medicare is a national healthcare service available to senior citizens and those under the age of 65 with certain disabilities. Medi-Cal is California’s Medicaid program. Medicaid services cover low-income individuals and families in need of medical care.

Is Medicare free?

Medicare Part A is free to most people because they paid Medicare taxes while working. If you don’t qualify for this, you can pay up to $506 monthly for Medicare. Additional costs accrue for Part B, C, and D. Visit the federal government website for more information on Medicare costs.

How much does Medicare cost per month in California?

Medicare Part A can cost anywhere from $0 to $506 per month, depending on your situation. Visit for more pricing information.