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Best Medicare Advantage Plans in California for 2019

Once you’re enrolled in Medicare Part A and Part B, you’re eligible to sign up for the best Medicare Advantage plan in California for your specific health circumstances. These Medicare Advantage plans are also known as Medicare Part C and are designed to take the place of your Original Medicare card. Monthly premiums for Medicare Advantage plans in California for 2019 must be paid on top of your Medicare Part B premium. Medicare Part C plans in California will cover the benefits guaranteed through Medicare Part A and Part B plus additional options like wellness programs, routine vision, and dental coverage. A lot of these health plans also include Medicare prescription drug plans, too.

If you want a policy that is structured much like the insurance you may have received from an employer in the past, you should research the best Medicare Advantage plans in California for 2019. You will have some rules to follow, such as selecting in-network health care providers in a certain service area, but you will also limit your out-of-pocket expenses.

Best Time to Enroll in a Medicare Advantage Plan in California for 2019

Unless you’re enrolled in Medicare Part A and Part B early due to disability or End Stage Renal Disease ESRD, your first chance to sign up for Medicare Part C in California is during your Initial Coverage Election Period (ICEP). This window opens three months prior to your 65th birthday and closes three months after your birthday, giving you seven months to enroll.

Use that time to compare the best rates and terms online because each insurance company determines the coverage provided in each Medicare Advantage plan. Other than covering your standard Medicare Part A and Part B benefits, there are no standardized benefits for a Medicare Advantage plan in California.

In many cases, your Medicare Advantage ICEP will run simultaneously with your Original Medicare Initial Enrollment Period (IEP). You have the option to waive Part B of Original Medicare if you don’t want to pay the premium, but that disqualifies you for Medicare Advantage plan enrollment.

If you don’t sign up for a Medicare Advantage plan in California during the initial coverage election period, you can sign up during the 2019 Medicare Advantage plan  Annual Election Period (AEP). This period runs from October 15 to December 7 each year and gives you the best chance to switch from standard Medicare Part A and Part B to a Medicare Advantage plan. You may also qualify for Special Election Periods (SEP) outside of the Annual Election Period due to special circumstances. For example, when a company does not perform a contract renewal for its Medicare contract, then you will have an option to shop for another health insurance company to purchase your Medicare coverage from. If you move out of your provider network or lose your coverage through your job, you’ll have the opportunity to purchase a plan, too.

Do you want to cancel your Medicare Part C policy and go back to Original Medicare to receive basic Medicare Part A and Part B benefits? Take advantage of the Medicare Advantage Disenrollment Period, which is open from January 1 through February 14 annually.

Best Types Medicare Advantage Plans in California for Different Needs

While there are a variety of Medicare Part C plans in California available in 2019 to Medicare beneficiary, the following four are the most popular options:

1.  Preferred Provider Organization (PPO)

  • Each plan includes a network of preferred medical providers, including a network hospital and specialists.
  • You can visit a hospital or other providers outside of your network, but it will likely cost you more.
  • Most PPO plans include prescription drug coverage.
  • Most PPO Medicare Advantage plans in California allow you to see network specialists without a referral.
  • These are often considered the best type of Medicare Advantage plans for members who travel or live in multiple locations throughout the year as their network restrictions are usually less cumbersome.
  • Your insurance company may add special benefits beyond the standard Medicare Part A and B requirements, but your premium may increase as a result.

2. Health Maintenance Organization (HMO)

  • Most HMO Medicare Advantage plans are restricted to a network of medical providers.
  • You may receive out-of-network coverage for emergency services or select types of care, depending on the rules for your chosen plan.
  • HMO plans require you to choose a primary care physician, otherwise known as a PCP.
  • Most specialist appointments require a referral.

3. Private Fee-for-Service (PFFS)

  • This is the best plan if you want more flexibility. You aren’t required to obtain referrals, choose a primary care doctor or see in-network doctors.
  • Medical providers aren’t required to accept PFFS plans, but some policies include optional networks with providers willing to bill according to the plan’s payment terms. You should check with your preferred providers to see if they will accept this type of Medicare Advantage plan.
  • You can also enroll in a Medicare Part D Prescription Drug Plan if your fee-for-service plan doesn’t include drug benefits.

4. Special Needs Plans SNPs

  • You must meet medical criteria to sign up for Special Needs Plans. Can be the best Medicare Advantage plan in California for subscribers with chronic health conditions.
  • Special Needs Plans may include added benefits that are needed by patients diagnosed with chronic or institutional conditions.
  • Most Special Needs Plans will require each beneficiary to see in-network providers with the exception of emergency services.
  • Many applicants qualified for SNPs are dual-eligible, so they receive Medicaid or similar state benefits in addition to Original Medicare.

5. Medicare Savings Account (MSA Plans)

  • Although not as popular as HMOs and PPOs, this is an option.
  • With this type of plan, you will have a high-deductible Medicare Advantage plan.
  • In addition to your Medicare Advantage plan, you will also have a special savings account that is designed specifically to be used to pay for healthcare expenses.

Medicare Advantage Plans in California: Enrollment Statistics

  • The five largest counties in California are Los Angeles County, San Diego County, Orange County, Riverside County, and San Bernardino County.
  • In 2015, there were more than 5.5 million Medicare beneficiaries in California. More than two million of those beneficiaries were enrolled in Medicare Advantage plans.
  • California’s Medicare Advantage plan enrollment increased by approximately 6 percent in 2016 and another 5 percent in 2017.

How Does A Medicare Advantage Plan in California Cover Prescription Drugs in 2019?

Most Medicare Advantage plans in California for 2019 will include prescription drug coverage, so you may not need to sign up for a separate Medicare Part D Prescription Drug Plan. Policies without Medicare Advantage Prescription Drug plans are often referred to as MA plans and are often the plans offering the $0 premium. Plans with drug coverage are referred to as Medicare Advantage Prescription Drug Plans MAPDS.

Enrollment in Preferred Provider Organization PPO plans or Health Maintenance Organization HMO plans will disqualify you for Medicare Part D enrollment, so select your Medicare Advantage plan with care. You can enroll in Medicare Part D and Private Fee-for-Service PFFS plans simultaneously.

Medicare Advantage plans aren’t regulated by the federal government, so each insurance company can determine the benefits included beyond the guaranteed coverage of Medicare Part A and Part B. Some of the differences that you may want to compare include:

  • Prescription Drug Tiers
  • Copayments
  • Deductibles
  • coinsurance
  • Coverage restrictions

There is no formulary way to determine rates, but you can expect to pay more for MAPD policies with the best prescription coverage.

Network Restrictions on a Medicare Advantage plan in California for 2019?

There are many restrictions that may apply to Medicare Advantage plans in California, but there are three limitations that are most common:

  • Network Restrictions. Some Medicare Advantage plans require you to pick a doctor within a dedicated network while others give you more freedom. PPO or PFFS policies are the least restrictive.
  • Emergency Medical Care. How your medical expenses are covered if you need emergency care while traveling depends on the terms of your policy. Urgent care and emergency services are covered by HMO and PPO policies, but it may cost more if you see out-of-network providers.
  • Moving. You’re required to secure a new plan if you move to a new state. You will qualify for a special enrollment period.

Best Additional Benefits to a Medicare Advantage Plan in California

One way for insurance companies to make their Advantage policies more competitive is to add extra services like the following:

  • Silver Sneakers memberships
  • Medical transportation
  • Over-the-counter medication allowances
  • Routine vision and dental
  • Hearing services
  • Wellness programs

Keep in mind that a $0 premium policy isn’t likely to include many of these extras.

Top-Rated Companies Offering Medicare Advantage Plans in California for 2019

Even though there are a lot of options, it’s still smart to compare Medicare Advantage plans in California for 2019 between various providers to find the number one option for you. These are some of the top companies that offer these Medicare Part C plans in California:

Best California Medicare Resources

Signing up for Medicare Parts A and B is your first step. You may also want to read a complete description of benefits so that you’ll know what Medicare covers without additional Medicare health plans.

After you are signed up for Medicare and know what is and isn’t covered — such as some hospital expenses, temporary nursing home care and more — then you can talk to one of our agents. We know which companies are the best out of the 5-star rating system and can help you make the right choice for your Medicare Advantage plan in California for 2019, so give us a call for assistance today!