Why Medicare in California Is Different
One of the biggest reasons people choose to work with a local Medicare expert like me is because California has some unique laws that most other states don’t offer. The biggest example? The Medigap birthday rule.
Every year, during the 60-day window starting on your birthday, you can switch Medigap plans without undergoing health underwriting. That means no matter your health condition, you can change from one Medigap plan to another of equal or lesser benefits—no medical questions asked. This gives Californians more flexibility and peace of mind, especially if you want to find better rates or change carriers.
Medicare Advantage Plans in California
Let’s start with Medicare Advantage (Part C) plans. California is home to one of the most competitive Medicare Advantage markets in the country. Big-name insurers like Kaiser Permanente, SCAN, UnitedHealthcare, Anthem Blue Cross, and others offer a wide range of plans throughout the state.
If you’re in Los Angeles, San Diego, Sacramento, or the Bay Area, you’ll find dozens of $0 premium Advantage plans. These plans often come packed with extra benefits like:
- Dental, vision, and hearing coverage
- Grocery cards and meal delivery
- Fitness memberships
- Part B premium givebacks
Sounds great, right? And for many people, it is. But it’s not all upside.
Pros and Cons of Medicare Advantage
Medicare Advantage plans work with provider networks, which means your access to care is limited to doctors and hospitals in-network—unless you’re on a PPO plan, which gives you a bit more flexibility. If you travel often or live in different regions throughout the year, this can be a major limitation.
Another factor to keep in mind: out-of-pocket maximums. Many plans have annual maximums as high as $8,500. That’s the most you could pay in a year if you needed extensive care. For some, that’s too much financial risk to take on.
Medicare Supplement (Medigap) Plans in California
Now let’s talk about Medigap, also known as Medicare Supplement Insurance. These plans pair with Original Medicare (Parts A and B) and are designed to cover what Medicare doesn’t—things like co-pays, deductibles, and coinsurance.
The two most popular Medigap plans in California are Plan G and Plan N:
- Plan G: Covers everything except the Medicare Part B deductible.
- Plan N: Lower monthly premiums with small co-pays for doctor visits and ER visits.
With Medigap, you can go to any doctor nationwide who accepts Medicare. No networks. No referrals. This is a huge benefit if you value choice and travel often.
California’s Birthday Rule: A Major Advantage
Here’s where California shines. Thanks to the Medigap birthday rule, you get a once-a-year opportunity to switch your supplement plan without answering any health questions. If your premium went up or you’re looking for a new carrier with better service, you can make a change—no underwriting required.
Plan G premiums in California typically range from $130 to $200 per month, depending on your age, location, and the insurer. Just remember: Medigap doesn’t include prescription drug coverage, so you’ll also need to enroll in a Part D plan separately.
So Which Is the BEST Medicare Plan in California?
It depends on your priorities. Here’s a quick comparison:
| Feature | Medicare Advantage | Medicare Supplement |
|---|---|---|
| Monthly Premium | Often $0 | $130–$200+ |
| Network | Yes (HMO or PPO) | No (see any Medicare provider) |
| Prescription Drugs | Included | Separate Part D plan required |
| Out-of-Pocket Max | Up to $8,500/year | Very low (often under $300) |
| Extra Benefits | Yes (dental, vision, etc.) | No |
| Flexibility | Limited outside network | Full freedom nationwide |
| Travel | Limited coverage | Great for travel |
If you’re okay with staying in-network and love the idea of extras like dental or grocery cards, Medicare Advantage might be a great fit.
If you’d rather have predictable costs and the freedom to see any doctor that takes Medicare, especially if you travel frequently, a Medigap plan could be your best bet.
How to Decide: Get Personalized Medicare Help
Even with this overview, choosing the right Medicare plan can be a big decision. That’s why I always recommend speaking with a licensed Medicare agent who understands California’s laws and your unique situation.
If you’re unsure whether a Medicare Advantage or Medigap plan is best for you—or if you want to see if you can save money on your current coverage—I’d love to help.
Call our office today at 800-208-4974 to schedule a one-on-one consultation. We’ll walk you through your options, check your prescriptions, look at your doctors, and find the BEST Medicare plan in California for you.
Final Thoughts
Medicare in California offers more options than most states—and more opportunities to save money and get better coverage. Whether you’re just turning 65 or reviewing your existing plan, now is the perfect time to explore what’s available.
Take advantage of the birthday rule, understand the pros and cons of each plan type, and don’t hesitate to get expert help. The right guidance can save you thousands and give you peace of mind.
Alex Wender is the founder and CEO of Bluewave Insurance. He has been blogging about Medicare-related topics since 2010. Since then, he and his agency have helped thousands of people across the country choose the right Medicare to fit their needs.
