Medigap policies in California are designed to help fill gaps in Medicare coverage, but it's essential to understand how they work to make an informed decision.
You can enroll in a Medigap policy during your initial enrollment period, which starts three months before your 65th birthday and ends three months after.
There are 10 standardized Medigap policies in California, labeled A through N, each offering different levels of coverage.
Policy A is the most basic, covering only three of the six Medicare-approved benefits: Part A hospital stays, Part B medical services, and Part D prescription drugs.
In California, Medigap policies can be sold by private insurance companies, and you can choose from a range of providers.
Medigap Policy Options
You have eight to 10 Medigap options to choose from, each known by a letter: A, B, C, D, F, G, K, L, M, and N. They're standardized, meaning plans with the same letter name must provide the same basic benefits regardless of the insurer or location.
About 36 percent of original Medicare enrollees buy a private Medigap plan. You can buy any Medigap plan available in your state during the six months after you initially sign up for Medicare Part B.
Medigap (Supplement) policies are private insurance policies designed to pay the portion of covered medical costs that Medicare does not pay.
Supplement vs. Advantage
Medicare Supplement plans are a supplement to Original Medicare, accepted by any doctor and hospital that accepts Medicare. They help cover healthcare costs that are not covered by Original Medicare, like coinsurance, copayment, and deductibles.
About 36 percent of original Medicare enrollees buy a private Medigap plan, which is a type of Medicare Supplement plan. This means that many people are turning to private Medigap plans to help cover their out-of-pocket medical costs.
Medicare Advantage plans combine the benefits of Original Medicare with additional benefits, like prescription drug coverage. However, they typically require you to use doctors and hospitals within the plan’s network.
You can complement your Medicare Supplement plan with a standalone prescription drug plan, since Medicare Supplement plans don’t include prescription drug coverage. This can provide you with more comprehensive coverage.
Eight to 10 Options
You have eight to ten Medigap options to choose from, each represented by a letter: A, B, C, D, F, G, K, L, M, and N. These standardized plans provide the same basic benefits, regardless of the insurer or location.
Medigap policies are standardized, meaning plans with the same letter name must provide the same basic benefits. This gives you a clear idea of what to expect from each plan.
The federal government determines what coverage a Medigap policy provides, except in three states: Massachusetts, Minnesota, and Wisconsin. This ensures that you have consistent coverage options across the country.
You can buy any Medigap plan available in your state, and insurers can't turn you down or charge you more due to preexisting health conditions, during the six months after you initially sign up for Medicare Part B.
Advantage Coverage Pros and Cons
Medicare Advantage plans have their pros and cons. One of the main advantages is that they can offer lower out-of-pocket costs than Original Medicare.
Here are some key benefits of Medicare Advantage plans:
- Potentially lower out-of-pocket costs than Original Medicare.
- Benefits that Original Medicare can’t offer.
- No enrollment rejections due to pre-existing conditions.
- Better satisfaction levels and coordinated care than Original Medicare.
However, there are also some significant drawbacks to consider. For example, Medicare Advantage plans often have limited networks of doctors and hospitals.
Here are some of the main cons of Medicare Advantage plans:
- Limited networks of doctors and hospitals.
- Charges for seeing out-of-network providers.
- Steep out-of-pocket costs despite $0 premiums.
- Additional premiums may apply, averaging around $18 per month.
- Flat fee co-pays but higher costs for out-of-network care.
- Annual out-of-pocket limits for in-network and out-of-network services.
- Restrictions on extra benefits like dental, vision, and hearing care.
- Ineligibility to purchase supplemental Medigap policies.
Under 65, Disabled
If you're under 65 and eligible for Medicare due to disability, you may be able to purchase a Medigap policy.
There are fewer Medigap policies available to individuals under 65, and the premiums are higher than for those over 65.
Your right to purchase a Medigap policy ends after the first six months of eligibility for Medicare.
After that, you may not be able to get one, but at 65, you'll have a new open enrollment period and can purchase any Medigap plan with lower rates.
Those with End-Stage Renal Disease (ESRD) are not able to purchase a Medigap plan if they're under 65.
Coverage Details
Medigap policies in California offer standardized coverage options to help fill the gaps in Original Medicare. There are 10 standardized Medigap plans, labeled A to N, each offering different levels of coverage.
Plan G, for example, covers 100% of Medicare Part B excess charges, which can be a significant cost savings for Californians. This is especially true for those living in areas with high Medicare Part B premiums.
Medigap policies in California are guaranteed renewable, meaning your coverage can't be canceled as long as you pay your premiums.
Prescription Drugs
Medicare Supplement plans do not cover prescription drugs.
You have options available with Prescription Drug Plans, also known as Part D.
These plans are designed to help cover the cost of prescription medications.
Medicare Supplement plans do not include coverage for prescription drugs, so you'll need to explore other options.
Vision Services
Vision Services are a crucial aspect of Medicare coverage, and some plans offer additional benefits beyond traditional Medicare.
Plan G Extra and Plan F Extra include vision coverage for costs that are not traditionally covered by Original Medicare, such as eye exams, frames, eyeglass lenses, or contact lenses.
This means you can get the glasses or contacts you need without breaking the bank, which is a huge relief for many people.
Getting Coverage
To get Medigap coverage in California, you must first be enrolled in both Medicare Part A and Part B. You can purchase a Medigap policy from a licensed insurance company.
Medigap plans are standardized, with plans labeled A-N, and all companies must offer the same benefits for each lettered plan. You can choose from one of these plans, but it's essential to understand the changes made to Medigap plans, including new additions like Plans M and N.
You can purchase Medigap policies through licensed insurance agents who are authorized to sell these plans. Be cautious of anyone claiming to be a Medicare representative, as Medicare/Medigap does not have official sales agents.
In California, you can keep your current Medigap plan as long as you continue to pay the premiums, but you may consider switching to a new plan if your needs change or if you find more suitable coverage at a lower premium.
Medigap plans are designed to cover the 20 percent of covered Part B healthcare services that Medicare doesn't pay, along with some other healthcare costs. This is in contrast to Medicare Advantage plans, which don't allow supplemental insurance.
To find the right Medigap plan for you, use the Medicare.gov Plan Finder Tool, which provides an interactive tool for finding all Medicare supplement plans.
Plan Providers
In California, you have many insurance companies to choose from when it comes to Medigap policies. Aflac, Allstate, and Anthem Blue Cross are just a few of the many options available.
There are over 100 Medicare plan options to consider, including Medigap plans. Many people add a Medigap plan to their Medicare coverage to fill the gaps in Medicare Parts A and B.
You can buy any Medigap plan available in your state from a private insurance company. Insurers can't turn you down or charge you more due to preexisting health conditions during the six months after you sign up for Medicare Part B.
Here are some of the insurance companies that offer Medigap plans in California:
- Aflac
- Allstate
- Anthem Blue Cross
- Blue Shield of California
- Continental Life (Aetna)
- Elips Life
- Health Net Life
- Humana
- ManhattanLife
- UnitedHealthcare (AARP)
- United American Insurance Company
- United World
These insurance companies offer different Medigap plans, and what they charge can vary dramatically.
Cost and Options
You could have literally 100 or more Medicare plan options to choose from, which can be overwhelming. Many people just have Medicare Part A and Part B coverage, but you may want to add a Medigap plan to cover the gaps in Medicare Parts A and B.
About 14 million people add a Medigap plan, also known as Medicare Supplement insurance. You may also want a Medicare prescription drug plan, or Medicare Part D. Some people select a Medicare Advantage plan, also referred to as Medicare Part C, which is provided by a private insurance company or healthcare provider.
You can have up to 10 Medigap options to choose from, known as standardized plans with letters A, B, C, D, F, G, K, L, M, and N. Each plan provides the same basic benefits, regardless of the insurer or location. The federal government determines what coverage a Medigap policy provides, except in three states: Massachusetts, Minnesota, and Wisconsin.
Medigap plans can be costly, with rates that typically increase every year. This is why it's essential to comparison shop and work with a local Medicare insurance advisor to find the best plan for you.
Supplement Policies
Supplement policies are designed to pay the portion of covered medical costs that Medicare doesn't pay.
You can buy any Medigap plan available in your state, and insurers can't turn you down or charge you more due to preexisting health conditions, during the six months after you initially sign up for Medicare Part B.
Medicare Supplement plans are a supplement to Original Medicare, accepted by any doctor and hospital that accepts Medicare, and help cover healthcare costs that are not covered by Original Medicare.
Medicare Supplement plans don't include prescription drug coverage, but you can complement your coverage with a standalone prescription drug plan.
Policies are sold by private insurance companies, which means you'll likely have several choices of plans that have the same letter but are offered by different insurers in your locale.
Medigap policies are private insurance policies designed to pay the portion of covered medical costs that Medicare does not pay.
Frequently Asked Questions
What is the downside to Medigap plans?
Medigap plans, including Plan G, come with high monthly premiums and out-of-pocket Part B premiums. Additionally, they don't cover prescription drugs, which can add to overall healthcare costs.
What is the most common Medigap policy?
The most common Medigap policy is Plan G, which accounts for nearly 39% of all policyholders. It's a popular choice among Medicare beneficiaries, covering a wide range of healthcare expenses.
What is the birthday rule in California Medicare Supplement?
In California, the birthday rule allows Medicare Supplement buyers to enroll in a new policy without medical screening or a waiting period within 60 days of their birthday. This annual enrollment window provides a convenient opportunity to switch or purchase a Medigap plan.
What are the four most common Medigap plans?
The four most common Medigap plans are Plan G, Plan N, Plan A, and Plan B, which are often chosen by eligible individuals turning 65 due to their popularity and availability. These plans offer varying levels of coverage and benefits, making them a popular choice for those looking to supplement their Medicare coverage.
Is Medigap being phased out?
Medigap plans C and F are no longer available to new Medicare recipients as of January 1st, 2020. However, existing policyholders can still keep their current plans.
Sources
- https://www.blueshieldca.com/en/medicare/medicare-plan-types/medicare-supplement-plans
- https://medicaresupp.org/find-best-medigap-california/
- https://www.insurance.ca.gov/0150-seniors/0100alerts/SA-01-10B.cfm
- https://www.aarp.org/health/medicare-insurance/info-2023/guide-to-medigap-plans.html
- https://cchicap.org/medicare-plans-overview/medigap-plans/
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