Medicare Part C in California

Medicare Part Cis an alternative to the Original Medicare insurance coverage, which is now a combination of Part A and B. California Medicare Plan C provides similar coverage to Original Medicare but in a much different way. Enrollees of Medicare Part C plans in California will each have different costs and coverage, which depend on the specific insurance policy. Participants concerned with how much plans for Medicare Part C cost will need to look at the premium, deductible and coinsurance expenses of the plan. Discovering in-depth details about the Medicare program in California is important for residents eligible for coverage.

What is California Medicare Part C?

Medicare Part C is also known as Medicare Advantage plans or MA plans. Medicare Part C plans differ from the Original Medicare (Part A and B combined) because they are provided by private companies that have had Medicare approval. Part C Medicare plans includes both hospital and medical insurance found in the Original Medicare option. Rather than choosing any health care provider in the California Medicare system, those who enroll in Medicare Plan C will need to select doctors and facilities within the plan’s network. When petitioners apply for Medicare Part C, they need to select an insurance plan from a private provider.

Some individuals confuse Medicare Supplement Insurance (MediGap) with Part C. While Medicare Supplement Insurance is provided by private companies as well, MediGap only enhances coverage for Original Medicare benefits. In fact, you cannot have Part C and MediGap coverage at the same time.

There are different types of Medicare Part C plans, each which offer health insurance coverage in a unique way. With Health Maintenance Organization (HMO), you are only covered to visit doctors, other health care providers or hospitals within the plan’s assigned network. If you need to see a specialist, then you will need a referral from your primary care physician.

Preferred Provider Organization (PPO) Medicare Part C plans will have lower covered costs if you use hospitals, physicians and other health care providers who belong to the plan’s assigned network. You can use out-of-network providers but the associated costs are typically higher. Another Medicare Plan C type, Private Fee-for-Service (PFFS), is similar to Original Medicare. You are allowed to visit any hospital, physician or other health care provider, providing they accept the payment terms of your plan. The plan you are enrolled in will determine how much it will pay for the services and supplies you receive.

Medicare Part C Special Needs Plans (SNPs) provide specialized health care geared towards specific groups of people. For example, people who live in nursing homes, people who are eligible for both Medicare and Medi-Cal (dual-eligibility) and people who suffer from certain chronic medical conditions. Medicare Part CHMO Point-of-Service (HMOPOS) allow enrollees to have access to some out-of-network services and supplies in return for a higher copayment or coinsurance.

With Medical Savings Account (MSA) plans through Medicare Part C, you can combine high deductible medical coverage with a bank account specifically for medical costs. Medicare will deposit money directly into your account and you can use that money to pay for your health care throughout the coming year. MSA plans do not cover prescription medications.

To learn more about Medicare Plan C types, download our comprehensive guide.

How to Enroll in Medicare Part C Plans in California

You should enroll in a Medicare Part C plan as soon as you are eligible for coverage during your Initial Enrollment Period. If you want to enroll in Medicare Plan C after signing up for Original Medicare, you will need to wait for General Enrollment to open or qualify for a Special Enrollment Period. From year to year, insurance providers do have the option to leave the Medicare Plan C network or to make changes to the servicers they cover, so it is important that you stay informed about your provider’s coverage and costs. You can either enroll in a different Part C Medicare Advantage plan or join Original Medicare if your provider should opt out of the Medicare network.

When California residents are eligible to enroll in Medicare Part C they can apply for health insurance coverage in three ways. You can apply online and search for Medicare Part C health insurance plans from private providers. You can also call the Social Security office and make an appointment for a phone interview or at a local Social Security office.

What does Medicare Part C cost and cover in California?

Medicare Part C costs vary from plan to plan. You can find Medicare Plan C cost quotes and plan options to suit your needs by visiting the official Medicare website. Your out-of-pocket costs for a Medicare Part C plan will depend on a range of factors including whether your plan includes an additional premium or has an annual deductible for certain services. Additional factors to consider is how much you have to pay in copayments or coinsurance for each service. Choosing the Plan C that works for financially best for you involves comparing the type of services and supplies you use to what the insurance plan covers.

Medicare Part C plans are required to cover the same services that Original Medicare Parts A and B cover. If you enroll in Medicare C, thenOriginal Medicare will still have to cover your hospice care, some of the costs for clinical research studies and some of the newer Medicare benefits. Whether you have Medicare C or Original Medicare, your urgent care and emergency care are covered. Most Medicare Advantage Plans also offer extra coverage such as dental care, vision card and health wellness programs. Most plans also include a prescription medication coverage.

If you require a medical service or supply that Medicare Part C plans do not cover or is not medically necessary, then you may have to pay for the expense out of pocket. You have the right to appeal your Medicare Plan C provider about the decision. If you are not certain about what services and supplies your Medicare C provider covers, then you can contact them and ask for an advance coverage decision. This written document will explain if the service or supply you need is medically covered and, if not, why.

To learn more about Medicare Part C costs, download our comprehensive guide.


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.