Looking for a good Medicare Advantage plan? Read on to find one!
California is home to great healthcare, and if you’re eligible, Original Medicare can be a great option to get the coverage you need. But as great as Original Medicare can be, Medicare Parts A and B don’t cover everything. If you’re looking for more comprehensive and expansive Medicare coverage, a Medicare Advantage plan (also known as Medicare Part C ) can be the best way to go! But given the variety of insurance plans provided by federally approved insurance companies, it can be difficult to know which Medicare Advantage plan is right for you.
If you’re looking to find a Medicare Advantage plan that provides affordable and effective health insurance, keep reading and be sure to check out Insurify’s comparison tool!
There are plenty of Medicare Advantage providers in California, but which one is right for you? We compiled the best plans in the state and ranked them based on several factors. Those factors including the entire cost of the plan, the variety of services offered, and the CMS rating– based on user-reported quality of care. For more information on our ranking procedure, see our methodology page.
1. Scripps Signature offered by SCAN Health Plan (HMO) - Score: 76.25
2. Scripps Plus offered by SCAN Health Plan (HMO) - Score: 76.25
3. WellCare Plus (HMO) - Score: 73.17
4. Scripps Classic offered by SCAN Health Plan (HMO) - Score: 73.13
5. SCAN Prime (HMO) - Score: 72.16
6. Kaiser Permanente Senior Advantage San Diego (HMO) - Score: 71.86
7. WellCare Best (HMO) - Score: 71.5
8. Sharp Direct Advantage Platinum Card (HMO) -Score: 70
Let’s take a closer look at the top eight, and then we will cover the best plans beyond Kaiser Permanente.
Monthly Premium: $74
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $2,500
Counties: San Diego
Though the monthly premium is higher than average, the out-of-pocket maxim is much lower than average. You’ll also find one of the lowest co-pays around for in-patient stays — with just $150 per day for the first five days and no co-pay for days six through 90!
Preventive care visits are free. Primary care visits cost $10, and specialists cost $25 per visit. You’ll also find low diagnostic copays, with most set at $0 per service. The only exception is radiology, which is set at $50 per visit.
You’ll find benefits for hearing, dental, and vision — so long as the visit is for routine services. Even your hearing aids are provided with some support. And you can choose to add supplemental benefits at your discretion.
Monthly Premium: $31.50
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $445
Out-of-Pocket Limit: $7,550
Counties: San Diego
Here we have a pared-down version of the Scripps Signature. Even so, you’ll find some advantages here including $0 copays to see your primary care doctor, specialist, and for any preventive service.
You’ll also be covered up to 80 percent of costs for diagnostic and hearing services. Routine care for dental, vision, and mental health care is covered with $0 copays.
Monthly Premium: $4.60
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $445
Out-of-Pocket Limit: $2,500
Counties: Ventura, Orange, Riverside, San Bernardino, San Joaquin; and Los Angeles where monthly premiums are $6.70 per month.
This is a low-cost healthcare plan all around. Copays to see your primary doctor, a specialist, or to receive preventive services are all free. You’ll also pay no copay to go to an urgent care unit instead of an emergency room.
Vision, hearing, and dental services are also covered with a $0 copay, so long as those services are routine.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $3,400
Counties: San Diego
With this health plan, you’ll find $10 primary care copays and $35 specialist co-pays. But preventive care is still free. The main drawback of this plan — and possibly why it’s so inexpensive— is the lack of dental care. You’ll need to add a stand-alone dental plan for that.
Vision, hearing, and mental health are still covered at generous rartes. You’ll also find a $0 copay for diabetes supplies — excluding durable medical equipment and prosthetics.
Monthly Premium: $23
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $699
Counties: Orange, Riverside, San Bernadino, Los Angeles.
Before we get into the details, do be aware that your monthly premium may be slightly higher depending on your county. With that said, you’ll find a generous plan with SCAN Prime. That includes $0 for preventive, primary care, and specialist visits. You’ll also pay $0 in copays to go to urgent care instead of the emergency room.
Vision, hearing, mental health, and preventive dental have low or no-cost copays for most services. Hearing aids come with an affordable $200-$400 copay. However, comprehensive dental is less generous.
Even so, with a low out-of-pocket maximum limit, this plan makes care quite affordable.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $4,000
Counties: San Diego
This plan keeps operating costs low— free preventive care visits, $5 co-pays for doctor visits, and just $15 to see a specialist. Additionally, the $225 copay for hospital stays only lasts through the first week. For days eight through 90, the copay is free.
The main drawbacks of this plan include no dental coverage and very limited hearing coverage (only exams are covered). But you will find assistance with vision care and generous support for mental health.
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Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $1,000
Counties: Riverside, San Bernardino, Ventura, San Joaquin, Los Angeles, Orange
First, we must note that your costs will vary a bit depending on your county. The highest out-of-pocket maximum is set at $2,500 for the year. But even the highest limit is still very affordable compared to many plans in California — especially considering the $0 premium.
That low-cost premium gets you quite a lot including generous copay rates for prescriptions. You’ll also stay inpatient in the hospital for $0 per day for the first 90 days of care. Plus $0 copays for primary, specialist, and preventive visits.
You also get $0 copays for routine dental, vision, and hearing. Plus $0 for hearing aids and comprehensive dental. Mental health services are higher than most on this list with a $40 copay per outpatient visit.
Monthly Premium: $58
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $2,900
Counties: San Diego
Rounding out our list is another low-cost and highly-rated plan. To be sure, this plan may not offer quite as many free services as others. But customers give the plan high marks for customer service.
You’ll find $5 copays for primary visits and $20 copays for specialists. Preventive care visits are free. Low-cost copays are also available for routine dental, hearing, and vision services. Comprehensive dental is covered, just at higher rates.
Of course, this list only scratches the surface of all the plans available in California. For a quick, easy, and totally free way to compare California Medicare Advantage plans, check out Insurify’s comparison tool! It’ll help you find the right plan for your medical and financial needs.
The general costs of Medicare Advantage plans can come from different sources:
Monthly premium: This is the monthly payment you must make to maintain your health insurance policy. It’s important to note that if you enroll in a Medicare Advantage plan, you will still need to pay the Medicare Part B premium.
Deductible: This is the amount of money you must pay out of pocket for medical services before your coverage kicks in. Once you meet your deductible, your insurance plan will begin to either directly cover medical costs or compensate you for covered medical services.
Coinsurance: Once you meet your plan’s deductible, the plan will begin to cover a percentage of medical services. Typically, the plan will pay a large percentage of these costs, leaving you to pay a smaller percentage.
Co-pays: As with coinsurance, co-pays become active once you’ve met your plan’s deductible and allow you to pay flat rates for specific medical services.
Out-of-pocket limits: This is the absolute maximum of what you can pay in medical costs during a given year. Once you’ve met this limit, your plan will completely pay for any subsequent medical costs.
To get a more concrete sense of Medicare Advantage costs in California, check out the table below:
When selecting a Medicare Advantage plan, the most important thing to remember is to take your own medical and financial situation into account. Take stock of your medical needs, as well as any financial limitations that might affect the affordability of some plans. By combining these two factors, you’ll be sure to find a plan that covers everything you need without putting any significant strain on your wallet.
When looking at plans, consider ones that provide coverage for specialist medical services that you need. If it’s prescription drug coverage you’re after, verify that the plan includes the medication you need by looking at the plan’s formulary. Also, be sure to check the plan’s service area to make sure you can enroll.
Each Medicare Advantage plan also comes with a star rating. Medicare awards star ratings to various plans based on a handful of factors. For Medicare Advantage plans:
Efficacy of screenings, tests, vaccines, and other preventative services
Assistance in managing chronic illnesses
Responsiveness from the plan provider
Member complaints and the number of plan disenrollments
Customer service
Star ratings can be a great way to get a sense of the quality of a health plan, though, as mentioned previously, be sure to check the plan’s finer details to make sure you have the coverage you need.
If you want to get started on finding the right Medicare Advantage plan for you, check out Insurify’s plan comparison tool! It’s free and easy to use and will give you accurate, side-by-side comparisons of the best Medicare Advantage plans on the market.
While it’s important to compare and contrast Medicare Advantage plans to find the best one for you, it’s equally important to know the different kinds of Medicare Advantage plans available in California:
Health Maintenance Organization ( HMO ): HMO plans provide coverage for doctors, healthcare providers, and hospitals in your plan’s network. Any visits to providers out of your network will generally not receive coverage unless those visits are for emergency or urgent care. For specialist services, you will need a doctor’s referral.
Preferred Provider Organization ( PPO ): A PPO plan is generally flexible, allowing you to visit doctors or other healthcare providers out of your network (albeit at a higher cost ). For providers in your plan’s network, you can expect to pay less in coinsurance and co-payments.
HMO Point-of-Service ( HMO -POS): Similar to HMO plans, HMO -POS plans offer coverage for in-network medical services and providers. However, HMO -POS is slightly more flexible in that it provides some coverage for out-of-network medical services.
Private Fee-for-Service ( PFFS ): PFFS plans, while they generally have few limits on which medical service providers you can visit, reserve the right to decide how much they will cover for doctor visits, hospital visits, and other medical services.
Medical Savings Account (MSA): MSA plans essentially create a savings account that receives funds from the insurance provider. Though these typically have a high deductible, you can use the savings fund to pay for healthcare expenses. These plans typically do not cover prescription drugs.
Special Needs Plan ( SNP ): SNP insurance policies restrict eligibility to only include individuals who live in an institution (such as a nursing home ) or suffer from a chronic health condition (such as HIV/AIDS, end- stage renal disease, or diabetes). Dual Special Needs Plans ( D-SNPs ) exist for individuals that qualify for both Medicare and Medicaid.
Medicare Advantage Prescription Drug Plan ( MAPD ): MAPD plans roll health and prescription drug coverage into one plan. This type of plan serves as an alternative to the Medicare prescription drug plans you would have to enroll in if you had Original Medicare and needed prescription drug coverage.
Learn More: The Difference Between Medicare and Medicaid Explained
While Medicare Advantage plans typically offer a broader range of coverage than Original Medicare—such as vision, dental, and hearing benefits—they often come with a set of costs that are much more variable than Original Medicare. With Original Medicare, the cost and coverage are set and standardized across the board, though you’ll likely incur more cost when enrolling in a Medicare Part D plan.
However, with Medicare Advantage, things like service area can affect whether a plan is actually available to you. In addition, co-pays, coinsurance percentages, deductibles, and additional benefits can vary. One Medicare Advantage plan that includes prescription drug coverage might not include a medication you need in its formulary.
Before enrolling in a Medicare Advantage plan, make sure that you understand the cost and coverage it offers so you can make the best decision for your situation.
You can enroll for Medicare Advantage during your Initial Enrollment Period, which begins three months prior to your 65th birth month and ends three months after. However, you will need to first enroll in Original Medicare to get your Medicare number. You can do this by visiting the Social Security Administration website at SSA.gov.
Alternatively, you can switch to a Medicare Advantage plan during the Open Enrollment Period, which takes place from October 15 to December 7 every year. During this time, you can make various changes to your Medicare coverage, including switching to a Medicare Advantage plan.
From the fully 5-star list we provided, you can tell that Kaiser Permanente is a solid choice for finding highly-rated Medicare Advantage plans. Given that coverage varies from county to county in California, make sure that you narrow your search to plans that include your county of residence. While Kaiser Permanente has a lot of highly-rated plans, don’t think that plans from Scan Health Plan, Sharp Health Plan, or WellCare can’t offer you the coverage you need.
There are plenty of Medicare Advantage plans to choose from in California. Some may be affordable but are missing the coverage you need. Some might include your needed medications but could strain your wallet. The best thing that you can do is take stock of your medical needs, as well as your financial limitations. With those in mind, get to researching and comparing different plans to find the best one for you.
If you want an easy, free, and comprehensive way to find the right plan for you, Insurify’s plan-comparison tool is here for you!
See Also: What Is Medicare Advantage and Is It Right for You?
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