As a senior, there are a variety of health insurance plans to choose from. When you retire and are no longer enrolled in your employer-sponsored health plan, it is easy to get overwhelmed with the different health coverage options available. It is important for you to consider your own personal healthcare needs and financial situation before applying for coverage.

• Medicare
• Medicare Advantage
• Medicare Part D
• Medicaid Supplemental Insurance (Medigap)
• Medi-Cal (California Medicaid)

Medicare

What is Medicare?

Medicare is a federally funded insurance program for eligible participants age 65 years old or older. Medicare is divided into four parts - Part A, Part B, Part C, and Part D.

• Medicare Part A provides inpatient / hospital stays as well as care from skilled nursing facilities, nursing home care (must not be a custodial or long-term care facility), hospice care, and some home health care.
• Medicare Part B provides outpatient / medical coverage for services that are medically necessary and preventative. This includes medical services such as mental health, clinical research, ambulance, durable medical equipment (DME), partial hospitalization, and limited outpatient prescription drugs.
• Medicare Part C, also known as Medicare Advantage, is an alternative way to receive Medicare benefits. Read more below.
• Medicare Part D provides coverage for prescription drugs.

For more information visit the Social Security Medicare Benefits page.

It is important note that Medicare does not cover 100% of all medical expenses or the cost of most long term care. For those with Original Medicare, the California Department of Insurance recommends purchasing a Medicare Supplement Insurance (Medigap) policy to help offset health care costs. 

How to apply for Medicare coverage?

You can enroll for Medicare 3 months before you turn 65 years old. 

To get more information on how to apply for Medicare, please visit Medicare.gov or contact your local Department of Aging (HICAP) for assistance. If you would like to get a printed copy of the “Medicare and You” handbook mailed to you, please call 1-800-MEDICARE (1-800-633-4227).

Medicare Advantage

What is Medicare Advantage?

Medicare Advantage or Part C, typically bundle Medicare Part A, B, and D to provide the benefits of Original Medicare, plus additional benefits. Medicare Advantage Plans are approved by Medicare, but are run by private companies that include Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). 

Additional benefit coverage includes:

• routine dental care (checkups & cleanings),
• vision care,
• hearing services,
• fitness memberships,
• and certain over-the-counter drugs.

Medicare Advantage Plans usually have lower out-of-pocket costs than Original Medicare, which is a good option for those who may need access to more medical services. You can compare Original Medicare vs. Medicare Advantage Plans to see which coverage works best for you.

How to apply for Medicare Advantage coverage?

To get more information on how to apply for Medicare Advantage, please visit Medicare’s website for Medicare Advantage Plans. If you have questions related to Medicare Advantage Plans, contact Medicare at 1-800-633-4227.

Medicare Part D

What is Medicare Part D?

Medicare Part D is a voluntary prescription drug program for Medicare beneficiaries. Prescription drug plans are sold by private companies but must be approved by Medicare. Before you purchase a prescription drug plan, it is important to make sure the one you are considering is approved by Medicare. Drug plans can have rules about what drugs are covered in different drug categories, so you should also make sure the plan you are considering covers any brand name drugs you are currently taking and wish to continue.

How to apply for Medicare Part D coverage?

To get more information on how to apply for Medicare Part D, please visit Medicare’s website for Prescription Drug Coverage. If you need financial assistance paying Medicare prescription drug plan costs, visit the Social Security page on how to apply for extra help. This is a Medicare Part D program to assist certain low income individuals with the cost of prescription drug coverage.

Medicare Supplement Insurance (Medigap)

What is Medicare Supplement Insurance?

Medicare Supplement Insurance (also known as Medigap) provides coverage for medical costs that are not covered by Original Medicare. Medicare Supplement plans are standardized and offer various benefits to help offset your healthcare cost.

How to apply for Medigap Coverage?

To get more information on how to apply for Medicare Supplement Insurance coverage, please visit the Guide to Medicare Supplement page. To purchase Medicare Supplement Insurance, you must be enrolled in Medicare Part A and Part B.

Medi-Cal

What is Medi-Cal?

Medi-Cal is California’s Medicaid program that provides health insurance for low-income individuals including seniors and persons with disabilities. It also provides needed health care services for families with children, foster care, pregnant women, and low-income people with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS. Californians who earn up to 138% of the Federal poverty level are eligible to apply for coverage.

How to apply for Medi-Cal coverage?

To get more information on how to apply for Medi-Cal, please visit your local County Medi-Cal office or visit the California Department of Health Care Services website. You can also call 1-800-541-5555 for more information and assistance. Each county in California determines eligibility, enrollment, and handles complaints. Covered California also accepts applications and can help you get coverage.

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