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Medicare Advantage Plans in California


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What are Medicare Advantage plans in California?

Medicare Advantage plans in California offer an alternative for beneficiaries who may be looking for coverage beyond Medicare Parts A and B and prefer the convenience of having those benefits included under a single plan. These plans cover at least the same hospital and medical benefits of Medicare Parts A and B and may include additional coverage for routine dental and vision care, hearing services, and prescription medications. If you enroll in a Medicare Advantage plan, you’re still enrolled in Medicare and part of the Medicare program; you’ll just be getting your benefits through your Medicare plan, instead of the federally administered program.

Medicare Advantage plans in California are offered by private insurance companies in the state that have contracted with Medicare. These plans fall under a number of types, including Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and Private Fee-for-Service plans (PFFSs). If you were in an HMO or PPO plan before you qualified for Medicare, you may be familiar with these managed-care plans, which are two of the most common types of Medicare Advantage plans. HMOs typically have a provider network of hospitals and doctors you must use to get coverage. These plans require a referral from your primary care doctor for specialist care. PPOs have more provider flexibility; you have the option to use doctors in the plan’s preferred provider network, or you can use out-of-network providers and pay higher costs. These plans don’t require primary care doctors, and you don’t need a referral before seeing a specialist.

If you’re interested in a Private Fee-for-Service plan, these plans do not have provider networks. Instead, you can use any doctor or hospital that agrees to the plan’s terms and conditions, on a case-by-case basis. Another option for beneficiaries interested in enrolling in a Medicare Advantage plan in California is a Medicare Medical Savings Account, or MSA plan. These Medicare Advantage plans combine a high-deductible health plan with a medical savings account. The plan deposits money into the savings account that can be used to pay for covered Medicare costs before the member has reached the plan deductible.

For beneficiaries who meet eligibility criteria, Special Needs Plans may be another option. These Medicare Advantage plans limit membership to those who have certain chronic conditions, receive Medicaid benefits, or live in an institution (such as a nursing home).

Beneficiaries can enroll in a Medicare Advantage plan in California during their Initial Coverage Election Period, the Annual Election Period (from October 15 to December 7), or a Special Election Period. The Initial Coverage Election Period is when you’re first eligible to enroll in a Medicare Advantage plan. It starts three months before you have Medicare Part A and Part B and ends on the last day of either your Initial Enrollment Period for Part B or the last day of the month before you are enrolled in Part A and Part B. For most people, the Initial Coverage Election Period takes place at the same time as the Initial Enrollment Period for Part B.

After your Initial Coverage Election Period is over, you’ll have to generally wait until the Annual Election Period (October 15 to December 7) to make changes. During this period, you can enroll in a Medicare Advantage plan for the first time, switch plans, or disenroll from your Medicare Advantage plan and return to Medicare Parts A and B.

If you change your mind and want to disenroll from your Medicare Advantage plan, you can also do so during the Medicare Advantage Disenrollment Period (January 1 to March 31); if you return to Medicare Parts A and B during this period, you can also enroll in a stand-alone Medicare Prescription Drug Plan.

Special Election Periods give eligible beneficiaries a chance to make coverage changes outside of regular election periods. You must have a qualifying situation, such as a loss of current health-care coverage or a recent move outside of your Medicare Advantage plan’s service area.

Prescription drug coverage with Medicare Advantage plans in California

In addition to hospital and medical coverage, some Medicare Advantage plans in California will also provide prescription drug coverage. Plans that include this benefit are referred to as Medicare Advantage Prescription Drug plans (or MAPD plans). Unlike Medicare Parts A and B, if you want prescription drug coverage and you have Medicare Part C, you should get this coverage through a Medicare Advantage plan that includes prescription drug benefits, not a stand-alone Medicare Prescription Drug Plan. In fact, if you enroll in a Medicare Prescription Drug Plan while you’re already enrolled in a Medicare Advantage Prescription Drug plan, you’ll be disenrolled from your Medicare Advantage plan and returned to Medicare Parts A and B. So, it’s important to be aware of how different parts of Medicare work together and how certain actions may affect your coverage.

When comparing Medicare Advantage Prescription Drug plans, be sure to double-check that your prescription medications are covered by the plan. You can do this by referring to the plan’s formulary, which is a list of covered drugs. Keep in mind that costs may vary by plan, even to cover the same medications, so it’s important to shop around to find the best coverage for your situation. Formularies are subject to change at any time. Your plan will notify you when necessary.

Choosing a Medicare Advantage plan in California

Because there may be a variety of Medicare Advantage plans in California to choose from, it is important to shop around for the plan that suits your unique medical needs. Compare the different benefits included with the Medicare Advantage plan, as well as the amount of coverage provided. It is also important to weigh the cost of each plan to ensure you find affordable coverage for your situation. Particularly if you take prescription drugs, Medicare Advantage Prescription Drug plans can vary widely in costs like copayments and coinsurance. Some Medicare Advantage plans in California offer $0 monthly premiums, while others may have higher premiums. Keep in mind that you must still pay the Part B premium even if you are enrolled in a Medicare Advantage plan that doesn’t require a separate plan premium.

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