New to Medicare in Los Angeles, CA

Your Los Angeles Medicare Guide 

If you’re new to Medicare or thinking about a change in Medicare plans, you’re likely considering your options. In the Los Angeles area, we’re lucky to benefit from many insurance companies competing to sell these options to those over age 65: 

• Medicare Advantage 
• Medicare Supplement (Medigap)
• Medicare Part D (Prescription Drug Plans)
• Optional senior dental coverage 

Depending on your situation, one Medicare option may be better. You could get Original Medicare with a Medigap Supplement and an optional Part D plan (then add-on dental). 

You could also choose an all-in-one Medicare Advantage plan. Medicare Advantage plans offer Part A, Part B, and Part D benefits, plus dental cleanings and fitness memberships. 

Here’s my general guide to your Medicare options. Remember that the right choice for you is very individual. It depends on your doctors, medications, and budget, and it’s always wise to get an expert opinion before choosing a plan — whether from me or another insurance agent you trust. 

Medicare Advantage Plans in the Los Angeles Area 

There are dozens of Medicare Advantage plans available in the Los Angeles area. Most L.A. residents I speak to want to know if their Medicare Advantage plan covers one of these top-tier medical groups: 

• UCLA Health: Six hospitals around Los Angeles as part of the University of California Los Angeles medical system, along with specialists and access to clinical trials. Primary health clinics are scattered throughout the area, including Beverly Hills and Manhattan Beach.
• Cedars Sinai: Among the U.S.’s largest nonprofit academic medical centers, with a massive hospital near West Hollywood, and almost 5,000 physicians, nurses, specialists, and healthcare professionals. 
• Providence Medical Group: The not-for-profit organization offers around a dozen hospitals and medical centers in Santa Monica and other local areas, including San Pedro and Torrance.

Understandably, the clients don’t want to lose access to these excellent doctors or facilities.

But even if you’re not committed to a particular medical network, ensure your Medicare Advantage plan covers providers and urgent care near your home. You don’t want to spend your best retirement years stuck in traffic, traveling from Santa Monica to Downtown Los Angeles for appointments. 

(However, remember that if you’re in an accident, you’ll be sent to the nearest hospital, whatever it may be. You won’t have a choice, for safety reasons.)

Some people on Original Medicare decide to switch to Medicare Advantage if their Medicare Supplement plan and Part D become too expensive and unaffordable. As mentioned before, a Medicare Advantage plan wraps Part D, Part A and Part B all into one plan. 

Is Medicare Advantage Right For You?

If you can find an MA plan that fits your budget and covers your existing medical network, you might find it’s a good fit. Just remember that you may need to manage more referrals. 

Medicare Advantage plans can also change the medical groups they work with. That’s why it’s essential to review your ANOC letter every year.

A handful of Medicare Advantage plans are sold only by the company’s internal agents, not an independent agent like me. Most current Kaiser Permanente enrollees want to stay with Kaiser after becoming eligible for Medicare. 

That’s understandable. But I can’t help you buy a Kaiser Permanente Medicare Advantage plan, for example. Kaiser’s MA plans are only sold by their internal agents.

L.A. Medicare Advantage OTC Benefits (and More)

Most Medicare Advantage plans offer basic benefits such as: 

• Dental coverage for preventive care such as cleanings 
• Vision coverage for exams and glasses 
• Some hearing coverage
• Fitness club memberships
• OTC benefits give you a debit card to spend on everyday items. 

MA plans may offer transportation if you no longer drive around L.A.’s streets. 

At least one Medicare Advantage plan in Los Angeles provides more unusual benefits. It covers acupuncture, an OTC card that can be used at Trader Joe’s, and higher international emergency benefits than most MA plans.  

Some MA plans also offer Part B givebacks along with OTC cards. I encourage clients to look at the big picture and plan fine print — after all, your OTC benefits won’t cover medical surprises like a new diagnosis or emergency surgery. 

In 2025, more Medicare Advantage carriers removed boutique gyms in Los Angeles from Silver Sneakers benefits. For example, you could join Orange Theory or Stretch Lab in 2024. In 2025, that benefit is gone. 

If you get a Medicare Advantage over-the-counter card or benefit, you’ll probably need to use it at one of the larger chain pharmacies or grocery stores. Most debit cards get reloaded every quarter. 

Some Medicare Advantage OTC cards allow you to spend money on groceries. Others restrict you to vitamins, toothpaste, and other typical OTC items. 

Medicare Supplement Plans in the Los Angeles Area 

Perhaps you don’t want Medicare Advantage but Original Medicare. Unfortunately, original Medicare doesn’t cover all your out-of-pocket costs. 

So private companies sell Medicare Supplement Insurance (Medigap) to help pay your out-of-pocket expenses. You must enroll in one of these plans when you first enroll in Medicare to be eligible for something called “guaranteed issue.” This means there are no questions asked about your health.

In California, 11 Medigap Plans are available in 2025: 

• Plan A
• Plan B
• Plan C 
• Plan D
• Plan F
• Plan F High-Deductible
• Plan G 
• Plan G High-Deductible 
• Plan K
• Plan L
• Plan N

Significant differences exist between the Medicare Supplement plans. Some cover more out-of-pocket expenses, some cover less, and only some people qualify for a few (such as Plan F). The Medigap plans can also differ in price. 

Specific Medicare Supplement plans are more commonly found or even required in California. In our famous 90210 ZIP code, 26 private companies sell Medigap Plan A. Only three sell Medigap Plan D. Almost 30 companies sell the popular Medigap Plan G.

Popular Medigap Plans in Los Angeles

In my experience, the most popular Medicare Supplement plans for Californians are Plan G and Plan N, but for slightly different reasons. 

Most Medicare beneficiaries choose a Medicare Supplement plan based on premiums. Medigap Plan G is the cheapest and provides the most out-of-pocket coverage. The monthly Plan G cost can start as low as around $150 for premiums, but much of this premium is based upon your age.

Keep this caveat in mind, though — with most insurers, the Medicare Supplement pricing will increase as you age. Some Plan G plans can cost up to $800 or more in extreme cases as you age, and if you’re a higher-risk enrollee. Yes, per month. It’s very important to consider long-term costs. 

A few Medicare Supplement carriers in L.A. offer Innovative G or G Extra. These Medigap plans give up to $100 in OTC benefits every quarter, some hearing benefits, and a personal emergency device. These are normal in Medicare Advantage but unusual extras for a Medicare Supplement plan. 

Medicare Supplement Plan N has a lower monthly premium and is predictable and dependable. When you see a doctor, you pay a flat fee of $20, and an emergency room visit costs $50. Few doctors will charge the “excess charges” that many are worried about with this plan, but it can happen. 

Around 10 companies offer High-Deductible G and High-Deductible F in Los Angeles. These are solid, low-cost Medigap plans, and the monthly cost can easily start at under $100 per month and stay low. These high-deductible Medigap plans have a $2,870 deductible in 2025, but that amount will likely go up in 2026. This amount changes every year. 

With a high-deductible plan, you’re essentially self-insuring for the deductible. The remainder of your year’s qualifying expenses are covered if you meet the deductible. However, you should know that, typically, most people I know don’t meet their deductible in the calendar year. 

Choosing a Medigap Company in L.A. 

Once you decide on the plan letter you want, you’ll want to compare rates at different companies. Around two dozen or so sell the most popular plans, such as Plan G. Some seem to price the premiums very high — as if they don’t want more customers. Or at least not more customers at that age for that particular plan letter, in that California ZIP code.

For example, premiums for a Los Angeles Plan N for a 65-year-old woman could range from around $110 a month to $220 a month. But despite your different prices, you’ll receive the same coverage for out-of-pocket expenses. 

As with Medicare Advantage, independent agents can’t sell you some plans, including Medigap plans from USAA and State Farm. If you find a lower rate with one of these companies for your age, I recommend you go with that Medigap plan. 

Due to California and federal law, insurance companies can only set their rates based on a few factors, such as your age or location. 

A community-rated plan usually doesn’t cost as much every year at renewal. An age-rated plan can increase dramatically as you get older. 

When you’re shopping for plans, ask not just what the rate is this year but how much you’d pay at age 80. 

Discounts for Los Angeles Medigap Plans

The standard discounts are for not using tobacco or for enrolling in the same plan as someone in your home. These are also known as spouse discounts or roommate discounts. However, each company sets its own rules and discounts.  

Some Medigap plans also give you a first-year $25 “new to Medicare” discount. You only get this discount when you first qualify for Parts A and B. If you delay Part B because you have employer health benefits, you can’t get this discount later on. 

California Birthday Rule 

Every year, between April and July, you’ll get a letter or another notice informing you of a Medicare Supplement cost increase. 

So here’s some good news. In California, you can switch to an equal or lower Medicare Supplement plan for 60 days following your birthday. So, if your birthday is June 15, you can switch to a new carrier or a new plan letter after that date.  

The California Birthday Rule allows Californians to switch Medicare Supplement plans without medical underwriting so they won’t be denied or charged more due to pre-existing conditions.

This is a fairly good compromise. In many states, you’re simply locked into your Medicare Supplement insurance plan forever. In New York, you can switch at any time of the year, but the Medigap rates are ridiculously expensive. 

Here’s the sticking point, though. With the California Birthday Rule, you can only switch to a Medigap plan with the same or fewer benefits than your current plan. If you are on plan N, you can’t go up to plan G with underwriting.  It must be Plan N to Plan N or Plan G to Plan N.

This is why speaking with an expert when first signing up for Medicare is critical. 

If you try to shop for a Medigap plan outside of your birthday month, you’d have to go through underwriting, which you likely don’t want to do. However, you can call to strategize with an agent at any time and try to figure out your options. 

Medigap Plans in Los Angeles: Quick Guide 

• It’s unethical for someone to sell you a Medigap plan if you have a Medicare Advantage plan; it’s either one or the other. 
• Switching from Company A to Company B for $2 savings on your Medigap plan is probably not worth the hassle. But if you’re looking at a difference of $40-50, you might consider a change for your birthday if you live in California. 
• If you buy an identical Medigap plan with a different company, there truly won’t be a difference. Claims will be paid as always. 
• Your Medigap annual enrollment date has nothing to do with Medicare open enrollment. It is only based on the 60 days after your birthday. 
• You might receive notice of a Medicare Supplement premium increase for 2025 or 2026, then have to wait until your “Birthday Rule” comes into effect. It’s best to do so. You can switch to another carrier with the same plan without underwriting. 

Los Angeles Area Standalone Part D Plans

If you’re on Original Medicare, there aren’t many Part D plans to choose from in the L.A. area, but they do complete your bundle of coverage, along with the Medigap plan. 

The good news is that you don’t have to go to a big chain if you love your mom ‘n’ pop pharmacy or local pharmacy. Sometimes, the big chains don’t have your prescription in stock. You depend on a local pharmacy you’ve gone to for years to fill your prescriptions. Your Part D plan should cover that medication fill, but always check with your Medicare agent.   

However, some Medicare Advantage or Part D plans might give you a cheaper copay or even a $0 copay if you use specific chains for mail-order or in-person pickup. Please feel free to contact our office today for your no-cost consultation.