Compare Medicare Advantage plans and quote side-by-side to get the best rate here.
About to celebrate a birthday in the Sunshine State and thinking about enrolling in Medicare in California? You’re eligible to sign up for Medicare 3 months before your 65th birthday and 3 months after. Medicare is a complex subject — Benzinga is here to break it all down so you can decide which plan is best for you based on your California location, budget and health needs.
Best Medicare in California:
- Aetna: Best Overall & Innovation
- Smart HMO: Most Affordable
- Anthem Blue Cross: Best Coverage & Corporate Responsibility
What is Medicare?
Medicare is a federal health insurance program designed to cover the basic health care needs of seniors aged 65 and above. The program is divided into 4 parts:
Part A plans cover inpatient hospital stays, skilled nursing facilities and some home care.
Part B plans cover doctor, specialist and other outpatient appointments. Part A and Part B plans are known as Original Medicare.
Part C plans, known as Medicare Advantage plans, refer to all-in-one Medicare coverage from private insurance companies. Part C plans replace Part A and Part B. Medicare Advantage plans often include extras not found in Original Medicare plans, such as wellness incentives and fitness programs. Many Medicare Advantage plans also offer prescription drug coverage, but Original Medicare plans don’t include it.
Part D plans cover prescription drug costs, can be offered as standalone plans or added on to Original Medicare or Medicare Advantage plans.
Medicare supplemental insurance plans or Medigap plans are designed to fill in the gaps not covered by Original Medicare or Medicare Advantage plans. Medigap plans are offered by private insurers.
Legalities of Medicare in California
Your Medicare rights in California are the same as in any other state. Medicare is a national insurance program for individuals and spouses who are 65 and older and who have paid Medicare taxes during their working years. Those enrolled are guaranteed certain rights:
- Fair and ethical treatment
- The health care services you’re entitled to
The Center for Medicare and Medicaid Services (CMS) is the federal agency that administers the Medicare program and works with state governments to ensure Medicare beneficiaries receive the services they’re entitled to and also make sure that Medicare Advantage plans are high-quality, accessible and affordable. Private insurance companies must adhere to CMS standards and guidelines. They can be fined or penalized or their plan can be terminated if they fall short. You can find claims and appeals resources on CMS.gov and Medicare.gov if you feel your rights have been violated.
Types of Medicare Advantage Plans
There are 2 main types of Medicare Advantage plans: health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Health Maintenance Organizations (HMOs)
HMOs are Medicare Advantage plans that consist of regional networks of doctors, specialists and hospitals. You choose a primary care doctor within the network and if you need to see a specialist, you must get a referral from your doctor. HMO plans are usually cheaper than PPOs and more restrictive.
Most HMOs require plan members to stay healthy by keeping their blood pressure down, exercising, eating right and not smoking — and there are programs available to help you get back on track. You can’t switch primary care doctors unless you do so through the plan.
Preferred Provider Organizations (PPOs)
PPOs are Medicare Advantage plans that feature a large network of doctors, specialists and hospitals that all agree to accept established rates for services and care. PPOs allow members the freedom to see any doctor they’d like to within the network and referrals aren’t needed. You’ll pay a bit more if you see providers outside the network.
All Medicare Advantage plans are given star ratings from CMS based on annual performance, customer satisfaction, provider choice, accessibility and rates. Star ratings range from 1 (poorest) to 5 (outstanding). New plans won’t usually be assigned a star rating until they’re on the market at least 1 or 2 years.
How to Sign Up for Medicare Advantage in California
About 6 months before your 65th birthday, you’ll receive a lot of brochures from private insurance companies promoting their Medicare Advantage plans. Most offer free informational seminars you can attend to help you make your decision.
You can also visit Medicare.gov, the official U.S. government’s site for Medicare information. The site, run by CMS, explains Medicare and your rights, and features resources such as claims and appeals, forms and a plan finder tool that allow you to put your information in so you can compare plans. You can also sign up for a Medicare Advantage plan on the site.
Another way to sign up is to contact a sales agent from the company of your choice. The sales agent will walk you through the process. You must sign up for Medicare 3 months before you turn 65 or 3 months after — if not, you could pay a stiff penalty. One exception to this rule, known as the Special Enrollment Period, allows you to enroll in a plan if you’ve experienced a life-changing event such as a marriage or move.
Another exception is if you already have Medicare and want to enroll in a 5-star plan, you can do so even if it’s not during open enrollment. Medicare’s Open Enrollment Period, which runs from October 15 through December 7, is the only time you can switch plans.
Average Cost of Medicare Advantage Plans in California
The average costs for Medicare Advantage plans in California range from $2,080 to $7,850, according to Medicare.gov. Rates depend on many factors such as location, income and plan features such as prescription drug coverage, dental, hearing and vision options. Here are a few examples of plan rates:
|Plan Name||Company||Plan Type||Health and Drug Costs||Star Rating (out of 5 stars)|
|Smart HMO||Alignment Health Plan||HMO||$2,080||4 stars|
|StartSmart Plus||Anthem Blue Cross||HMO||$2,970||4.5 stars|
|Medicare Select Plan||Aetna||HMO||$3,460||3.5 stars|
|Medicare Choice Plan||Aetna||PPO||$5,500||4 stars|
|Original Medicare||Federal Government||N/A||$7,850||N/A|
Of course, these rates are estimates and vary from plan to plan, so check with individual providers to verify the prices and features included.
Best Medicare Providers in California
We’ve gathered information from Medicare.gov and J.D. Power and Associates to bring you our list of best Medicare plans in the Golden State.
1. Best Overall in California: Aetna
Aetna’s Medicare Advantage plans came in 4th in J.D. Power and Associates’ 2019 Medicare Advantage Study. The study measured:
- Coverage and benefits
- Provider choice
- Customer service
- Information and communication
- Billing and payment
Aetna’s HMO plan is rated 3.5 stars and its PPO plan is rated 4 stars, so they’re both above-average plans, according to the government's standards. Many offer prescription drug coverage as well as free fitness programs.
2. Cheapest Medicare Plan in California: Smart HMO
Alignment Health Plan’s Smart HMO plan is the cheapest you can buy in California at approximately $2,080 a year. It’s not included in the J.D. Power and Associates Study but it’s worth considering. This plan includes prescription drug coverage and has an above-average star rating of 4.
3. Best Coverage for Medicare in California: Anthem Blue Cross
Anthem Blue Cross’ StartSmart Plus HMO plan is worth checking out — its star rating is 4.5 out of 5. Plus, it’s affordable, at $2,970 a year. Anthem Blue Cross comes in 7th place in the J.D. Power and Associates Study and Medicare.gov’s plan finder includes the plan in its list of Medicare Advantage plans in California.
4. Best for Corporate Responsibility: Anthem Blue Cross
Anthem Blue Cross has received a few awards in recognition of its corporate responsibility accomplishments, including:
- Chairman’s Award from the Boys & Girls Clubs of America
- Gold Stevie Award for Corporate Responsibility
- Better Buildings Goal Achiever from Department of Energy
- Outstanding Corporate Leader from Sustainable Roundtable, Inc.
Awards like this don’t directly impact Anthem’s Medicare Advantage plans or prices — it’s good knowing that a company has been recognized as a socially responsible leader.
5. Best for Innovation: Aetna
Aetna is known as an innovator in the health insurance sector — it’s received several awards, including:
- IBM Mainframe Mobile App Throwdown for an app designed to help nurses who conduct home visits easily manage their patient’s medication.
- CSO50 Award for its solution that allows customers and regulators real-time access to security information.
- Tech Exec Network finalist for its Central Project of the Year for being first in the industry to create a solution addresses common regulatory compliance questions in an audit data vault and provides a single checkpoint for multiple assessors.
It’s important to choose a company that uses cutting-edge technology to improve your customer experience when you use its website, mobile app and other tools. An innovative health insurance provider is always working behind the scenes to make your life easier.
Save Money: Compare Medicare Advantage Plans
Enrollment in Medicare Advantage plans has nearly doubled over the past 10 years — more than 20 million people have enrolled. Of the 10,000 people turning 65 every day, many choose Medicare Advantage plans because they offer health care services and features they need at affordable prices.
Competition for members is fierce among Medicare Advantage plan providers, which means it’s a buyers market, and that’s good news for you. Tools like the Medicare.gov plan finder and resources such as CMS.gov and J.D. Power and Associates means it’s easier than ever to research and compare plans to find one that’s right for you.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.