Understanding Medicare Eligibility in California

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Medicare can be a confusing program, and newly Medicare-eligible Californians likely have many questions. HealthMarkets can help you better understand the program, decide on supplemental policies, and select a Medicare plan.

Who Has Medicare Eligibility in California?

In 2018, there were 3,762,104 eligible California residents receiving Original Medicare. Original Medicare includes Part A, insurance that covers inpatient stays in a hospital, and Part B, medical insurance that covers doctor visits and outpatient services. You can qualify for Original Medicare if you are a U.S. citizen and one of the following describes your personal situation:

  • You’re 65 or older. 
  • You’re under 65, permanently disabled, and receive disability benefits from Social Security or the Railroad Retirement Board.
  • You have end-stage renal disease (ESRD).
  • You have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s disease.

When Am I Eligible for Medicare Part C, Part D, and Medicare Supplement Plans? 

After you sign up for Original Medicare, you are eligible to enroll in Medicare Advantage (Part C), a prescription drug plan (Part D), or Medicare Supplement plans. Medicare Advantage includes Parts A and B, and often contains coverage for prescription drugs.

There are a number of reasons why Medicare Advantage may be preferred to Original Medicare, including:

  • Copayments instead of coinsurance. Those enrolled in Medicare Advantage plans are more likely to pay a fixed amount per doctor’s visit, instead of paying a percentage of the cost. 
  • Dental, vision, and hearing coverage. Original Medicare does not cover these services, but many Medicare Advantage plans include them.
  • Caps on out-of-pocket costs. Medicare Advantage plans have a cap on how much you pay in out-of-pocket expenses per year. Original Medicare does not have a cap.

A Medicare Supplemental plan may be right for you, too, especially if you are looking to fill gaps in your coverage. Find out how to maximize your Medicare benefits and confirm your Medicare eligibility in California. HealthMarkets licensed insurance agents are ready to answer your questions and help you find a Medicare plan that's right for you.  Contact us today online or at (800) 439-6916.


https://www.kff.org/medicare/state-indicator/distribution-of-medicare-beneficiaries-by-eligibility-category-2/ | https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/ | https://www.medicare.gov/what-medicare-covers/what-part-a-covers | https://www.medicare.gov/what-medicare-covers/what-part-b-covers

The Right Coverage at the Lowest Price

Your search for affordable Health, Medicare and Life insurance starts here.

Call us 24/7 at (800) 827-9990 or Find an Agent near you.

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