Medicare Advantage Plans California – Broad Healthcare Coverage

California is among the states with the highest life expectancy in the US. The average life expectancy is 81 years, with nearly 6 million people aged 65 years and above. As such, there is a wide range of Medicare Advantage (MA) plans to choose from across the state.

What Do Medicare Advantage Plans in California Cover?

Medicare Advantage plans in California are required to cover all of the services that are covered by Original Medicare, including hospital care, medical care, and some preventive services.

This means that Medicare Advantage plans must provide coverage for hospital stays, doctor’s visits, lab tests, other medical services, and some preventive services, such as flu shots and cancer screenings.

In addition to the services covered by Original Medicare, many Medicare Advantage plans in California also offer additional benefits and services that Original Medicare does not cover.

These additional benefits and services may include coverage for prescription drugs, dental care, vision services, and hearing aids. Some plans may also offer extra support for managing chronic conditions, such as diabetes or heart disease, or coordination of care with other healthcare providers.

Furthermore, many Medicare Advantage plans in California offer prescription drug coverage as part of their benefits package.

The specific Medicare part D coverage may vary depending on the plan. Some plans cover a wider range of medications than others and may have a different copayment or coinsurance amount for each medication.

Some plans may also have restrictions or exclusions on certain medications or require prior authorization for certain medications.

Types of Medicare Advantage Plans in California

You can choose from various Medicare Advantage plans if you are a Medicare beneficiary in California. The most common types of MA plans available in California include the following:

Health Maintenance Organizations (HMOs)

They provide healthcare services to members through a network of healthcare providers. HMOs typically require members to choose a primary care physician who coordinates their care and provides referrals to specialists as needed.

They often have lower premiums and out-of-pocket costs than other types of health insurance, but they also have more restrictions on the covered providers and services.

Typically, they only cover services provided by in-network providers and may require pre-authorization for certain procedures or medications.

This means that members may have to pay out-of-pocket for care received from out-of-network providers or for services not covered by their plan.

Despite these restrictions, HMOs can be a good choice for people looking for affordable healthcare coverage and willing to see in-network providers. They can also be a good option for people comfortable working with a primary care physician to coordinate their care.

Preferred Provider Organizations (PPOs)

These types of MA plans are provided through a network of preferred providers. Unlike HMOs, PPOs do not require members to choose a primary care physician and do not require referrals for specialty care.

PPOs often offer more flexibility than HMOs, but they also have higher premiums and out-of-pocket costs. In most cases, emergency care is covered in the plan.

Members of a PPO plan can see any provider within the network without a referral from a primary care physician. They can also see out-of-network providers, although they will have to pay a higher share of the cost for those services.

PPOs often offer more freedom of choice than HMOs but also have higher premiums and out-of-pocket costs.

They are a popular choice for people who want more flexibility in their healthcare options and are willing to pay a higher price for that flexibility.

They are favored by people who want to see a specialist without getting a referral from a primary care physician or by those who want the option of seeing an out-of-network provider.

Private Fee-for-Service (PFFS)

They are a type of Medicare Advantage whereby the insurer pays medical care providers a set rate for different services. PFFS plans differ from other Medicare Advantage plans because they allow members to see any provider willing to accept the plan’s terms and conditions, regardless of whether the provider is in-network or out-of-network. Therefore, you do not require pre-authorization or referrals.

PFFS plans have more flexibility than other Medicare Advantage plans but also have higher out-of-pocket costs. Members of a PFFS plan may have to pay a higher share of the cost for services received from out-of-network providers or for services not covered by the plan.

PFFS plans can be a good option for people who want more flexibility in their healthcare choices and are willing to pay a higher price for that flexibility. They are often preferred by people who want to see a provider not in the plan’s network or by those who want the option of seeing an out-of-network provider.

Special Needs Plans (SNPs)

SNPs are designed to provide tailored healthcare coverage to specific groups of Medicare beneficiaries. They are available to people who have certain chronic conditions, such as diabetes or heart failure, or who have special healthcare needs, such as being dual-eligible for Medicare and Medicaid.

SNPs are designed to provide coordinated and comprehensive care to their members and may offer additional benefits and services beyond what Original Medicare covers.

These additional benefits and services may include extra support for managing chronic conditions, access to specialists, and coordination of care with other healthcare providers.

An SNP is a special needs plan and is a good option for people with special healthcare needs who want a Medicare Advantage plan tailored to those needs.

They can provide access to a coordinated and comprehensive care team and may offer additional benefits and services that can help to improve health outcomes and quality of life.

Medicare Medical Savings Account (MSA)

MSA plans combine a high-deductible health plan with a savings account. MSA plans are designed to give members financial incentives to make more cost-effective healthcare choices.

An MSA plan pays for Medicare-covered services after the member meets the plan’s deductible. Any money the member saves by making more cost-effective healthcare choices is deposited into a savings account, which the member can use to pay for future healthcare expenses.

MSA plans are a good option for people looking for a Medicare Advantage plan with lower premiums and out-of-pocket costs.

They can also be a good choice for people interested in taking a more active role in managing their healthcare spending and making more cost-effective healthcare choices.

Top Medicare Advantage Plan Providers in California

There are more than 450 California Medicare Advantage Plans. Some of the largest and most well-known MA plans providers in California include:

• Kaiser Permanente
• Anthem Blue Cross
• Humana
• United Healthcare Medicare Advantage
• Aetna Medicare
• Blue Shield of California
• Cigna Medicare advantage
• Health Net
• SCAN Health Plan
• Sharp Health Plan
• Alignment Health Plan
• Brand New Day
• Central Health Medicare Plan
• Chinese Community Health Plan
• Clever Care Health Plan
• Wellcare by Health Net
• Western Health Advantage
• Imperial Health Plan of California, Inc.
• Inter Valley Health Plan
• Innovative Integrated Health Community Plans

How to Choose the Best Medicare Advantage Plan in California

To choose the best plan for you, it is important to carefully review the available options and consider the following factors:

• Coverage and benefits: Make sure that the plan covers the services and medications you need and that it offers any additional benefits or services you want, such as dental or vision coverage or support for managing chronic conditions.
• Network of providers: Check to see if your current healthcare providers are in the plan’s network or if you will have to switch providers to receive covered services.
• Out-of-pocket costs: Compare the plan’s premiums, deductibles, copayments, and coinsurance to see how much you will have to pay out-of-pocket for covered services.
• Customer service and ratings: Look for a plan that has a good reputation for customer service and has received high ratings from organizations such as Medicare and the National Committee for Quality Assurance (NCQA).

It is also a good idea to talk to your healthcare providers and trusted friends or family members to get their recommendations and advice on choosing the best Medicare Advantage plan in California.

Additionally, you can contact Health Insurance Counselling and Advocacy Program for free for personalized help in choosing and enrolling in a Medicare Advantage plan.

Conclusion

There are over 450 California Medicare Advantage plans to choose from. The specific plans available to you will depend on the county you live in and your individual needs.

To find out which Medicare Advantage plans are available in your area, you can use the Medicare Plan Finder tool on the Medicare website.

You can learn more about Medicare Advantage plans and compare different plan options on the Medicare website or by contacting a Medicare insurance agent.

A Medicare representative can help you understand your options and make an informed decision. Alternatively, contact California health advocates for assistance.