Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage combines the benefits of Medicare Part A and Medicare Part B into a single plan. Also known as Medicare Part C, this type of coverage differs from Original Medicare because it’s offered by private insurers instead of the federal government. Each Medicare Advantage Plan must provide at least the same level of coverage as Original Medicare (with the exception of hospice care covered by Medicare Part A), but many insurers offer additional benefits, such as dental, vision and hearing services, transportation to medical appointments and senior wellness programs.
Unlike Original Medicare, almost all Medicare Advantage Plans include prescription drug benefits, so there’s no need to purchase supplementary prescription coverage. Although Medicare Advantage providers must follow rules established by the Centers for Medicare & Medicaid Services, they’re allowed to set their own out-of-pocket costs and have different rules regarding referrals or the use of in-network health care facilities. Out of the 6.4 million residents who were eligible for Medicare in California in 2020, about 2.8 million are enrolled in Medicare Advantage, approximately 44% of the state’s Medicare-eligible population. This is slightly higher than the national average of 42%.
This guide provides an overview of Medicare Advantage Plans in California, including what these plans cover, what makes a resident eligible for Medicare Advantage and how to find and enroll in a Medicare Advantage Plan.
The Top 10 Medicare Advantage Plans in California
California has several insurance companies participating in Medicare Advantage. This gives Medicare-eligible residents access to a wide range of plan options. The table below lists the top 10 most popular Medicare Advantage providers according to their enrollment numbers. Most companies offer multiple Medicare Advantage Plans, so cost information is displayed as a range rather than an average price. We also added the enrollment numbers for each plan together to determine a provider’s total enrollment within the state. Plan information was accurate as of April 2022, but you can go to Medicare.gov for up-to-date information on the plans available in your area.
SCAN Health Plan
Anthem Blue Cross
Blue Shield of California
Wellcare by Health Net
Alignment Health Plan
Brand New Day
How Medicare Advantage Plans Work in California
Before enrolling in Medicare Advantage, it’s important to understand how the program works in California. Insurers typically offer multiple plans, from health maintenance organizations (HMOs) to preferred provider organizations (PPOs). Each type of plan has different requirements regarding the need for referrals, in-network versus out-of-network coverage, prescription drug coverage and the need to choose a primary care provider. You’ll find a description of the four most common plans below.
What Medicare Advantage Plans Cover in California
With the exception of hospice care, Medicare Advantage Plans must cover the same services available to Original Medicare beneficiaries. These services include preventive screenings, lab tests, X-rays and care provided during a hospital admission. Medicare Advantage providers are also allowed to offer extra benefits, such as dental care, vision care and hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in California
To qualify for Medicare Advantage, an applicant must already have Medicare Part A and Medicare Part B, live in the plan’s service area and meet all other Medicare eligibility requirements. Medicare enrollment is limited to adults who are at least 65 years old or have some type of disability that would qualify them for Medicare at a younger age. Every Medicare enrollee must also be a U.S. citizen or lawful immigrant. Like other types of health insurance, Medicare has limited enrollment periods, so it’s important for seniors to understand when they can enroll in Medicare or change plans. See the list below for more information about enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this is the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in California
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
California’s Health Insurance Counseling and Advocacy Program (HICAP) is a Medicare and long-term care counseling service for seniors. HICAP can help California residents understand how to enroll in Medicare and the various aspects of the program, determine which Medicare plan type is best for them, and have any related questions about Medicare and long-term care answered. One-on-one counseling is available free of charge for eligible California residents. To be eligible, one must be at least 65 years of age and eligible for Medicare, or be younger than 65 but will be eligible for Medicare in the near future or have a disability. HICAP also holds educational events, which are open to people of all ages.
California Health Advocates is a non-profit focused on Medicare advocacy and education. The group provides accurate and timely information for Medicare beneficiaries and their families to help them better understand the program and make the most of their health care coverage. Subscribers can access the group’s comprehensive fact sheets that cover a range of Medicare-related topics specific to California, including Medicare Advantage. California Health Advocates also publishes a regularly-updated, Medicare-focused blog on its website with hundreds of helpful articles.
The California Department of Managed Health Care (DMHC) helps protect consumer rights and assists members of managed care plans (such as HMOs) with any problems to ensure all patients “receive the medical care and services to which they are entitled.” It also conducts plan compliance checks and issues public reports of its findings. On its website, the DMHC has information on California Medicare, choosing the right type of health care plan, enrollees’ health care rights, and more.
The DMHC is located in Sacramento, CA and can be reached via phone at 1-888-466-2219. The department may also be reached by email via this contact form. For more information on how to reach specific offices within the department, visit the DMHC website.
California’s Office of the Patient Advocate evaluates California health care plans based on patient experience and quality of care and gives each plan a rating based on this data. The ratings are published on the group’s website so consumers can research health care plans prior to enrolling. The group also rates hospitals and health groups and provides educational information such as the differences between different Medicare plan types. It also publishes annual reports of health care complaints made by California consumers.
California’s Aging and Disability Resource Connection provides several support services, including “options counseling.” This counseling service can help connect Californians to public and private support services, including health care programs like Medicare. The services are available to anyone regardless of age, income, or ability.
The MSSP provides services to seniors in order to help them remain in their own homes and communities. One of the many available services is a complete health assessment to help seniors determine their needs. The MSSP team then works with the individual to develop a care plan. This assessment and support can be beneficial to seniors considering Medicare Advantage but who are unsure if it is the right decision for their health and financial situation. MSSP services are available to low-income California residents who qualify for Medi-Cal and are 65 years of age or older.