Medicare Costs and Coverage in California


California Medicare costs vary depending on a number of factors including your income and the plan type in which you enrolled. The four types of Medicare insurance coverage for California residents have different shared costs required of beneficiaries. Medicare premiums and co-pays are distinct between plans as each provides different covered health care services. Eligible applicants should know the cost and coverage of each Medicare plan before enrolling. In some cases, Medicare Saving Programs can provide additional financial assistance to individuals and couples. Continue reading to find out more about paying for Medicare and Medicare coverage in California.

What does Medicare cover in California?

Determining what Medicare covers free of charge or at a discounted amount depends on the enrolled plan. The Original Medicare insurance plan is actually a combination of two plans, Part A and Part B. Many enrollees prefer Medicare A and B coverage combined, since the mixture provides comprehensive health care insurance. However, since Part B has required Medicare premiums, which are contingent on earnings, some residents waive coverage when applying for Medicare in California.

Medicare Part A coverage includes the cost for hospital, hospice or a skilled nursing facility admission. It covers all the expenses that are necessary for your inpatient care including nursing services, a semi-private room and meals. This applies to care within critical care, long-term care and acute care hospitals.

Medicare Part B coverage includes inpatient and outpatient health care services not covered by Part A as well as preventive care like flu shots. Part B also covers supplies needed for treatment and medical equipment such as blood sugar monitors and wheel chairs.

Medicare Part C coverage is not a stand-alone plan but rather a section of the program that allows private insurance providers to offer coverage to Medicare beneficiaries. These private health insurance plans, such as PPOs and HMOs, are called Medicare Advantage Plans and combine Medicare A and B coverage

Medicare Part D coverage includes payment for outpatient prescription drugs. This plan adds prescription coverage to Original Medicare as well as some Medicare Private Fee-for-Service (PFFS) Plans, Medicare Cost Plans and Medicare Medical Savings Account (MSA) Plans.

For comprehensive information about what Medicare covers by plan, download our California state guide.

California Medicare Premiums Explained

Medicare costs include premiums, deductibles and co-pays or coinsurances for medication, medical equipment and services rendered. Premiums for Medicare are the cost of enrolling in the plan broken down into monthly payments, the same as other health insurance policies. Medicare co-pays, coinsurance and deductibles are the cost of using the plan. Co-payments and coinsurances are partial payments for services or medication, which may be a fixed amount or a percentage of the total cost. Deductibles are sums towards health care services that the beneficiary is responsible for covering before the insurance plan aids with costs.

If you have Medicare Part A coverage, then you will not have to pay a monthly premium, typically. Medicare Part A coverage is free to eligible claimants and claimants’ spouses who paid Medicare taxes while employed and meet other requirements for premium-free Part A. Medicare Part B coverage has premiums that vary based on your modified adjusted gross income. In 2017, premiums for Medicare Part B range from $100 to 430 approximately.

The Medicare premiums you pay on Part C and D will depend on the type of plan you have and the extent of the coverage. The private insurance provider, not the government, establishes charges (monthly premium, deductible and co-pays) for enrollment in a Part C plan. Medicare Part D premiums may be included if combined with Part C or a Medicare cost plan, but will have a monthly cost if only combined with Part A and/or B. However, California residents who deter enrollment in Part D when first eligible may have higher premiums for Medicare Part D due to late enrollment penalties.

Medicare Co-Pays and Deductibles

Like Medicare premiums, costs of using insurance are contingent on the plan. Medicare Part A coverage has a reasonable deductible that you must pay before the insurance plan starts to pay. Part A Medicare insurance coverage for inpatient stays, for example, will not require a co-payment for the first 60 days after the deducible. However, a Medicare co-pay is required for each day following this period.

Medicare Part B coverage also has a deductible before it pays 80 percent, typically, of approved services, therapy and equipment. Co-pay for Medicare Part D is based on tiers, with generic drugs costing less than brand-names. For in-depth information about California Medicare coinsurance costs by part, review our state guide here.

Medicare Savings Programs

Four kinds of Medicare savings programs are designed to save you money if you are on a low income. If you are eligible for Medicare savings programs, then government may pay Medicare A and B coverage deductibles, coinsurance and copayments. The four programs are:

  • Qualified Medicare Beneficiary (QMB) Program: The monthly income limit range is $1,025 to 11,090.
  • Specified Low-Income Medicare Beneficiary (SLMB) Program: The monthly income limit range is $1,226 to 11,090.
  • Qualifying Individual (QI) Program: The monthly income limit range is $1,377 to 11,090.
  • Qualified Disabled and Working Individuals (QDWI) Program: The monthly income limit range is $4,105 to 6,000.

If you qualify for QI, SLMB or QMB, you are automatically eligible for Extra Help, a Medicare program that assists in paying for prescription drugs.

What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.

Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.