Medicare Plans & Guidance for California Seniors
Turning 65? Start With the Basics.
Your Initial Enrollment Period generally begins three months before the month you turn 65, includes your birthday month, and continues for three months afterward.
If you're approaching Medicare eligibility, it's a good idea to start reviewing your options before your 65th birthday.
Already have Medicare? Your coverage needs can change over time. We can also help existing Medicare beneficiaries review their current coverage and understand other available options when they're eligible to make a change.
New to Medicare? Start Here.
STEP 1 — Enroll in Medicare Parts A & B
If you aren't automatically enrolled, you can apply for Medicare through the Social Security Administration. ENROLL IN MEDICARE →
STEP 2 — Get Your Medicare Number & Card
After your Medicare enrollment is processed, you'll receive your Medicare number. You can also access your Medicare information through your Medicare.gov account. ACCESS MEDICARE.GOV →
Medicare Enrollment Guide
Who Qualifies?
This is for people who are first becoming eligible for Medicare, most often around age 65, and for some people who qualify earlier because of disability, ESRD, or ALS.
Enrollment Timeline
Your IEP is a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Missing this window can create coverage delays and possible Part B or Part D late-enrollment penalties.
Key Considerations
Review Original Medicare Part A and Part B, Medicare Advantage Part C, standalone Part D, and Medigap options. Doctors, prescriptions, pharmacies, travel needs, premiums, and expected out-of-pocket costs should all be checked before you enroll.
Who Should Review Coverage?
AEP is for people already on Medicare who want to review or change Medicare Advantage or Part D coverage for the next plan year.
Enrollment Window
AEP runs October 15 through December 7 each year. Changes generally take effect January 1. This is also when many people review their Annual Notice of Change, also called an ANOC, to see what is changing for the coming year.
Available Plan Changes
During AEP, you may be able to switch Medicare Advantage plans, change Part D plans, move from Original Medicare to Medicare Advantage, or return from Medicare Advantage to Original Medicare and consider separate drug coverage.
Qualifying Events
A SEP may be available when certain life or coverage changes happen, such as moving, losing employer or union coverage, entering or leaving a plan service area, qualifying for Medicaid, or receiving Extra Help with drug costs.
SEP Eligibility
SEP timing depends on the event and the coverage you already have. Some windows are short, so it is best to review your options as soon as the change happens.
Coverage Options
A SEP may allow you to enroll, disenroll, or switch plans outside AEP. The choices available depend on the qualifying event, your current coverage, and the type of Medicare plan involved.
Coverage Overview
Medicare Advantage, standalone Part D, and Medigap serve different needs. Medicare Advantage is private Medicare coverage, Part D helps with prescription drugs, and Medigap works with Original Medicare to help reduce certain out-of-pocket costs.
How Each Plan Differs
Medicare Advantage plans often use HMO or PPO networks and may include extra benefits. Medigap usually offers more provider flexibility with Original Medicare, but generally does not include Part D drug coverage. Part D plans vary by formulary, drug tier, pharmacy, and prior authorization rules.
Compare Before Enrolling
Compare more than the premium. Review MOOP limits, copays, coinsurance, formularies, drug tiers, preferred pharmacies, referrals, prior authorizations, provider networks, and whether underwriting may apply for Medigap outside certain windows.
Medicare Questions
Yes. There is no cost to use California Benefits Insurance Center for Medicare plan review help. Our licensed agents help you understand your options, compare plans based on your doctors, prescriptions, preferred pharmacies, and budget, and make choosing coverage as simple as possible.
Yes. California Benefits Insurance Center can review doctors, medical groups, hospitals, prescriptions, drug tiers, pharmacies, and formularies before you apply. This is especially important because Medicare Advantage networks and Part D formularies can change from year to year.
Medicare Advantage is private Medicare coverage that may use a network and often includes extra benefits. Medigap works with Original Medicare and can reduce certain out-of-pocket costs, but it usually does not include Part D prescription drug coverage. California Benefits Insurance Center can help explain how each option fits your needs.
No. Sometimes the best choice is to keep what you already have. California Benefits Insurance Center compares your current plan, doctors, prescriptions, costs, and benefits against available options so you can make a confident decision.
You may have to wait for another enrollment window unless you qualify for a SEP. Depending on the situation, missing the right window can also create coverage gaps or late-enrollment penalties. California Benefits Insurance Center can help you understand which enrollment options may be available.
Understanding Your Medicare Options
Medicare isn’t one-size-fits-all. Depending on your needs, you may choose Original Medicare alone or add coverage that helps with costs and benefits not included in Original Medicare.
Original Medicare — Parts A & B
Part A generally covers inpatient hospital care, while Part B generally covers doctor visits, outpatient care and other medical services.
Medicare Advantage — Part C
An alternative to Original Medicare offered by private insurance companies. Plans may combine hospital, medical and prescription drug coverage and may include additional benefits.
Medicare Supplement — Medigap
Works alongside Original Medicare and can help pay certain out-of-pocket costs, such as deductibles, copayments and coinsurance.
Prescription Drug Coverage — Part D
Helps cover the cost of prescription medications and can be purchased separately by people with Original Medicare.
Medicare Advantage Plans
Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare.
Many Medicare Advantage plans combine hospital and medical coverage and may also include prescription drug coverage. Depending on the plan, additional benefits such as dental, vision, hearing, fitness programs and other services may also be available.
Medicare Supplement Insurance
Medicare Supplement insurance, commonly called Medigap, works alongside Original Medicare to help cover certain out-of-pocket costs.
Unlike Medicare Advantage, a Medicare Supplement policy does not replace Original Medicare. Medicare remains your primary coverage, while your Supplement policy helps with eligible costs that Original Medicare does not fully pay.
There are several standardized Medicare Supplement plan types, and availability and premiums can vary.
Prescription Drug Coverage
Medicare Part D provides coverage for prescription medications through private insurance companies approved by Medicare.
Each plan has its own list of covered medications, known as a formulary, as well as its own premiums, pharmacy network and cost-sharing requirements.
Because prescription needs are different for everyone, reviewing your medications can be an important part of choosing Medicare coverage.
Medicare Advantage or Medicare Supplement?
Medicare Advantage and Medicare Supplement plans can both provide coverage beyond Original Medicare, but they work very differently.
Medicare Advantage plans provide your Medicare benefits through a private insurance company and may include prescription drug coverage and additional benefits.
Medicare Supplement plans work alongside Original Medicare and help cover certain costs that Original Medicare does not pay.
There isn't one option that's right for everyone. Your healthcare needs, budget, doctors, prescriptions and preferences can help determine which approach may be a better fit.
Not Sure Which Medicare Option Is Right for You?
That’s where we can help.
Our licensed agents can help you compare Medicare coverage based on the things that matter to you, including:
- Your doctors and preferred healthcare providers
- Prescription medications
- Hospitals and medical groups
- Monthly premiums
- Copays and other out-of-pocket costs
- Additional plan benefits
- Your individual healthcare needs
There is no single Medicare plan that is right for everyone. We’ll help you understand your choices so you can make an informed decision.
Medicare Help Doesn't End After You Enroll
Your Medicare needs may change over time. Plans can also change their premiums, benefits, provider networks and prescription drug coverage from year to year.
California Benefits Insurance Center can remain a resource after enrollment, helping you understand your coverage and review your options when you're eligible to make changes.
We're here to help you with Medicare today and in the years ahead.
When Can I Enroll or Make Changes to Medicare Coverage?
Medicare has specific enrollment periods that determine when you can enroll in coverage or make certain changes to an existing plan.
Initial Enrollment Period
If you’re becoming eligible for Medicare at 65, your Initial Enrollment Period generally begins three months before the month you turn 65 and continues for three months after your birthday month.
Annual Enrollment Period
From October 15 through December 7, Medicare beneficiaries can review their coverage and make certain changes for the upcoming year.
Medicare Advantage Open Enrollment Period
From January 1 through March 31, people already enrolled in a Medicare Advantage plan may have an opportunity to make certain changes.
Special Enrollment Periods
Certain life events or changes in circumstances may allow you to enroll or change coverage outside the standard enrollment periods.
Not sure whether you can make a change? We can help you understand which enrollment period may apply to your situation.
This is a solicitation for insurance. A licensed insurance agent may contact you.
We do not offer every plan available in your area. We represent multiple organizations and products. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
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