Medicare FAQs

Most people become eligible for Original Medicare (Parts A and B) at age 65, but are not automatically enrolled, except those receiving Social Security benefits 4+ months before 65. You must apply during your seven-month Initial Enrollment Period (IEP) to avoid late enrollment penalties, which can increase your Part A, Part B, and Part D premiums for life.

If you delayed Original Medicare enrollment due to employer health insurance coverage, you can avoid late enrollment penalties by enrolling during the Special Enrollment Period (SEP).

If you’re  switching from Covered California to Medicare, you need to take action and watch specific dates closely. If you miss deadlines, you could face higher costs. Report your Medicare status and cancel your Covered California plan at 800-300-1506.

You have various Medicare plan options to choose from, including Original Medicare, Medicare Advantage plans, Medicare Supplement (or Medigap) plans, and stand-alone Medicare Part D plans.

Each “Part” of Medicare covers different aspects of your healthcare. For example, Medicare Part B covers a range of necessary services, including doctor visits, outpatient care, and medical equipment. It also covers and covers home health services, hospice care, and other medical care needs.

Medicare Advantage plans wrap Part A and Part B together, and each plan has its own benefits, costs, and coverage. Beneficiaries should carefully review their options to find the best plan for their needs. You can also use online tools to compare Medicare plans and find the most cost-effective option.

In California, beneficiaries can generally choose from 11 Medigap plans, each represented by a different letter. However, not all plans are available in all counties. Typically, more plan options are available in more populous counties, such as Los Angeles County. 

The three most popular plan types  in California are Plan F,  Plan G, and Plan N, but Plan F is only available to Medicare beneficiaries eligible for coverage before January 1, 2020. Medigap plans help cover Medicare costs that are out-of-pocket.

You can’t keep your regular private health plan, but both Kaiser and Blue Shield offer Medicare-specific plans in some California counties. If you’re already a Kaiser member, you and your Medicare-eligible dependents could enroll in a Kaiser Permanente Medicare Advantage plan. Blue Shield also offers Medicare Advantage and Medicare Supplement (Medigap) plans in some California counties. 

Remember that your Medicare Advantage plan will offer different benefits, premiums, and drug coverage than your private plan.  Contact your current insurer or an agent about Medicare plan options.

Medicare.gov offers a “Care Compare” tool to find Medicare-approved California providers near you. Most California doctors accept Original Medicare, but call the doctor’s office to confirm. Call the doctor’s office directly and ask if they “accept Medicare assignment.” 

If you have a Medicare Advantage plan, check your plan’s provider directory for in-network doctors, but also call the office to ensure they’re still within your Medicare Advantage plan’s network. 

If you’re receiving Social Security disability benefits in California, you’ll be automatically enrolled in Medicare after 24 months of receiving benefits. 

You can also enroll in Medicare during the Initial Enrollment Period (IEP) if you’re eligible due to disability. Medicare coverage for people with disabilities can be complex, so contact Medicare directly or consult a licensed insurance agent for your situation.

Every year, different insurance companies enter the Medicare market to offer plans. Others leave markets. Two of the largest insurers with the most Medicare Advantage plan options are the well-known private insurance companies, Humana and UnitedHealthcare. Other popular Medicare Advantage companies are Aetna and Scan Health Plan. 

However, a variety of firms offer Medicare Advantage plans in California, including county-based regional health authorities and nonprofit health organizations.

In general, monthly costs range between $0 to $500 or more.

Most people get Part A for free if they or their spouse worked and paid Medicare taxes for at least 10 years. If you do have to pay, the Part A premium is $311 per month with 30-39 quarters of work history, or $565 per month with fewer than 30 quarters.  

The standard monthly Medicare Part B premium in 2026 is $202.90, although you could pay more if you have a higher income. 

If you add a Part D drug plan or Medicare Advantage plan, those costs vary by plan. Don’t forget that you’ll often also pay copays, deductibles, and other expenses out of pocket.

Medicare charges higher-income people more for their Part B monthly premium through the Income-Related Monthly Adjustment Amount (IRMAA). In California, as in other states, the $202.90 standard Part B premium rate applies to you if your income is a modified adjusted gross income (MAGI) of less than or equal to $109,000, or a married couple filing jointly with less than $218,000. 

If you earn more, monthly premiums in 2026 range from $284.10 to $689.90, depending on your most recent federal tax return.

Yes. “Extra Help” is a Medicare program to help those with limited income and resources pay Part D premiums, deductibles, coinsurance, and other costs. Individuals might qualify if their income is at or below 150% of the federal poverty level ($22,590 for individuals) and resources are less than $17,220. With Extra Help, both the Part D deductible and plan premium are waived, and in 2026, you’ll pay no more than $12.65 for brand-name drugs or $5.10 for generics. Apply at SSA.gov/extrahelp or call 1-800-772-1213.

If you can’t afford Medicare, you may qualify for Medicare Savings Programs (MSPs). These programs help pay your premiums, deductibles,  copays and other costs, but there are asset limits that limit your ability to get the benefits. 

Three programs are  based on monthly income:

• QMB (up to $1,235 single / $1,663 married): Covers Part A and B premiums plus cost-sharing
• SLMB (up to $1,478 single / $1,992 married): Covers Part B premiums
• QI (up to $1,660 single / $2,239 married): Covers Part B premiums

Asset limits in California: $130,000 for a single person and $195,000 for a married couple, for all three programs.

Medicare Savings Programs help pay your Part A and Part B premiums, and may also cover deductibles, coinsurance, and copayments. To qualify for QMB, your monthly income cannot exceed $1,305 if single or $1,763 for couples in 2025. Apply online at BenefitsCal, by phone at (866) 613-3777, or in person at your local county social services office.

You can call an agent like myself to help you with Medicare questions, as I work with a wide variety of California-based clients. In addition, you can call the California Department of Aging to navigate the Medicare system and access health care services. 

You can get health insurance counseling, advocacy programs, and information and referrals to find services and support. The department can also provide information and guidance on Medi-Cal and other programs that can help beneficiaries manage their health care costs.

Medi-Cal is California’s Medicaid program. If you’re eligible for both Medi-Cal and Medicare, you can enroll in Medi-Medi. These dual-eligible beneficiaries should get help understanding how the plans work together to provide coverage and manage health care costs.  

Medi-Cal can help pay for Medicare premiums, deductibles, and co-pays, and beneficiaries can apply for Medi-Cal through the California Department of Health Care Services.

Volunteer counselors at California’s Department of Aging can help you understand Medi-Cal and your specific rights and health care options. The counselors do not sell, recommend, or endorse any insurance product, agent, insurance company, or health plan. 

They also offer free educational presentations on Medicare and health insurance topics.. Call 1-800-434-0222 to find your local office, which depends on the California county you live in.

You can call Medicare at (800) 633-4227 to learn about coverage options and enrollment. However, you might also need assistance from the Social Security Administration: (800) 772-1213 to ask about your Medicare eligibility and start date.