Medicare Advantage in California
Understand the basic tradeoffs before comparing specific plans in your area. If you find a plan that fits, your agent can help you enroll.
Compare plans. Get help enrolling.
A licensed agent can help you review plans, check the details that matter, and enroll if you choose a plan.
What is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits. Plans are offered by Medicare-approved private insurance companies and must follow Medicare rules. Most Medicare Advantage plans also include Medicare prescription drug coverage.
Original Medicare
Original Medicare is administered by the federal government and includes Part A and Part B. You can generally use any doctor or hospital that takes Medicare. Drug coverage is usually added separately through a Part D plan, and some people purchase Medigap coverage.
Medicare Advantage
A Medicare Advantage plan provides your Part A and Part B coverage through a private Medicare-approved plan. Plans may use provider networks, set copays and other cost sharing, and often include Part D and additional benefits.
The plan types you are most likely to see
HMO
Health Maintenance Organization plans generally require you to use doctors, hospitals and other providers in the plan’s network except for emergencies, urgent care and certain other situations. A primary care doctor and referrals may be required.
HMO-POS
An HMO Point-of-Service plan is an HMO with a point-of-service feature. It may allow certain covered services outside the network, usually at a higher cost and subject to the plan’s rules.
PPO
Preferred Provider Organization plans have a network, but you can generally use out-of-network providers for covered services if they accept the plan. Out-of-network care usually costs more, and referrals are generally not required.
Special Needs Plan (SNP)
SNPs are Medicare Advantage plans for people who meet specific eligibility requirements, such as having certain chronic conditions, having both Medicare and Medicaid, or needing an institutional level of care. SNPs can use an HMO or PPO structure.
Other Medicare Advantage plan types, including Private Fee-for-Service (PFFS) and Medicare Medical Savings Account (MSA) plans, also exist. Compare Medicare Advantage plan types on Medicare.gov.
What the common cost terms mean
Plan premium
The amount you pay each month for the plan, if any. A $0 plan premium does not eliminate your Medicare Part B premium or other health-care costs.
Copays & coinsurance
Your share of the cost when you use covered services. Different services, such as specialists, hospital care or outpatient procedures, can have different amounts.
Maximum out-of-pocket
The annual limit on what you pay for covered Part A and Part B services under the plan. Prescription drug costs are handled separately under Part D rules.
What we can help you compare
You don’t need to research all of this on your own. Start your review with whatever you know, and we can help look up the details with you.
- Your doctors and hospitals.We can help check whether the providers you want to keep participate with the plans you’re considering.
- Your prescriptions.We can help review formulary coverage, drug tiers, deductibles and pharmacy options.
- Your expected medical costs.We can compare premiums, copays, coinsurance and maximum out-of-pocket amounts.
- Your preferred plan style.We can explain HMO, HMO-POS, PPO and eligible SNP options and how their network rules differ.
- Additional benefits that matter to you.Dental, vision, hearing, OTC, transportation and other benefits can be included in the comparison based on your priorities.
There is no single plan that is best for everyone
The practical fit depends on your location, providers, prescriptions, expected health-care use, budget and preferences. A licensed insurance agent can help you compare the plans our agency represents for your situation.
Ready to compare your options?
Start now with whatever you know. We can help look up the rest and compare the options with you.
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