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Explore Your Medicare Options

Get the information you need to make informed decisions about your Medicare coverage

Medicare 101

  • What is Medicare
  • The components of Medicare
  • Specifics for Californians in 2026
  • Choosing Your Path in California
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Medicare Advantage or Medicare Supplement

  • Which One Should You Choose
Learn more

What Original Medicare covers and what not?

  • What Medicare covers
  • What not covers
Learn more

Enrollment Period

  • Medicare enrollment
  • Covered California
  • Special Enrollment Periods
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Find quick answer from our resource library and fAQ

  • Medicare Basics

Medicare 101

Medicare is a federal health insurance program primarily for people age 65 or older, as well as younger individuals with certain disabilities. In California, while the core "Parts" (A, B, C, and D) remain the same, there are unique state-specific programs, consumer protections, and changes effective in 2026.

A
🏥

Inpatient hospital, skilled nursing, hospice.

Inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
2026 Monthly Cost
$0 (if you worked 10+ years).
B
🩺

Doctor visits, outpatient care, screenings.

Doctor visits,outpatient care, preventive services, lab tests, medical equipment, and more.
2026 Monthly Cost
$202.90
C
🌟

Medicare Advantage (Private "bundled" plans).

An all-in-one alternative to Original Medicare that may include extra benefits like vision, dental, and hearing.
2026 Monthly Cost
Varies by plan (many are $0 in CA).
D
💊

Prescription drug coverage.

Helps cover the cost of prescription medications through Medicare approved drug plans.
2026 Monthly Cost
Average is $34.50; $2,100 max out-of-pocket cap.

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Choosing Your Path in California

Original Medicare + Medigap + Part D

Best for those who want to see any doctor in the U.S. that accepts Medicare and prefer predictable costs.

  • Freedom to choose any doctor
  • Predictable out-of-pocket costs
  • Nationwide coverage

Medicare Advantage (Part C)

Often includes dental/vision and has low premiums, but requires using a specific network of doctors.

  • Low or $0 premiums
  • Extra benefits included
  • Common in SF Bay Area
  • Plan Comparison

Medicare Advantage

or

Medicare Supplement

Deciding between Medicare Advantage (Part C) and Medigap (Medicare Supplement) is a choice between lower monthly costs or more predictable medical bills. In 2026, the landscape has shifted slightly due to new out-of-pocket caps on prescription drugs.

Feature

Medicare Advantage (Part C)

Medigap (Supplement)

How it Works

Replaces Original Medicare with a private, "all-in-one" bundled plan.

Works with Original Medicare to pay for your 20% coinsurance and deductibles.

Monthly Premium

Often $0 (beyond your Part B premium).

Higher premiums (typically $130–$250+ depending on age/plan).

Provider Choice

Usually restricted to a network (HMO/PPO). May need referrals for specialists.

Any doctor in the U.S. who accepts Medicare. No referrals needed.

Out-of-Pocket Costs

You pay copays for most visits until you hit the plan's MOOP limit (up to $9,250 in 2026). Read More

Near $0 for covered services once you meet the Part B deductible ($283).

Prescription Drugs

Usually included (MAPD plans).

Not included. You must buy a separate Part D plan.

Extra Benefits

Often includes Dental, Vision, Hearing, and Gym memberships.

Generally none. These must be purchased as separate private policies.

Travel Coverage

Usually limited to emergencies only when outside your plan’s local service area.

Nationwide coverage. Some plans include foreign travel emergency care.

Which One Should You Choose ?

Consider Medicare Advantage if

  • You are generally healthy
  • You want to keep your monthly fixed costs as low as possible
  • You like the convenience of having your medical, drug, dental, and vision coverage all on one card

Consider Medigap if

  • You want total freedom to choose any specialist in the country
  • You travel frequently
  • You prefer a "subscription" model where you pay more upfront but have zero surprise bills when you get sick

Important 2026 Context

Regardless of which path you choose, all Medicare beneficiaries now benefit from the $2,100 annual out-of-pocket cap on covered prescription drugs starting in 2026. This significantly reduces the financial risk for those on the Medigap path who previously faced unlimited drug costs.

  • Coverage Details

What Original Medicare covers and what not?

Medicare in California for 2026 follows federal guidelines but includes unique state-level protections and significant cost updates. Coverage is generally divided into what the government provides (Original Medicare) and what private plans offer.

What Original Medicare Covers (Parts A & B)

Part A (Hospital Insurance)

  • Inpatient Stays: Semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment.
  • Skilled Nursing Facility: Care after a qualifying 3-day inpatient hospital stay.
  • Hospice & Home Health: Limited medically necessary skilled care at home.

Part B (Medical Insurance)

  • Doctor Visits: Includes specialists and outpatient mental health services.
  • Preventive Services: Vaccines (Flu, COVID-19), screenings for cancer, and annual "Wellness" visits.
  • Durable Medical Equipment (DME): Walkers, wheelchairs, and oxygen equipment.

Unique California Protections & Programs

The "Birthday Rule"

Best for those who want to see any doctor in the U.S. that accepts Medicare and prefer predictable costs.

Medi-Medi Plans

For those eligible for both Medicare and Medi-Cal, California is expanding integrated plans to coordinate all benefits.

Acupuncture Coverage

While Original Medicare only covers acupuncture for chronic lower back pain, many CA Medicare Advantage plans include it as a standard benefit.

Services Not Covered by Original Medicare

Medicare in California generally follows federal guidelines, but there are specific "gaps" in coverage that are important to know for the 2026 plan year.
While Original Medicare (Parts A and B) covers medically necessary hospital and doctor services, it does not cover several common health needs unless you have a private Medicare Advantage (Part C) plan that explicitly includes them.

Category

What is Excluded

Exceptions / Options

Dental Care

Routine cleanings, fillings, extractions, and dentures.

Covered only if related to another medical procedure (e.g., jaw surgery or cancer treatment).

Vision & Hearing

Routine eye exams, glasses, contact lenses, and hearing aids.

Covered only after cataract surgery or if a doctor deems a hearing test medically necessary.

Long-Term Care

"Custodial care" (help with bathing, dressing, eating) in a nursing home or at home.

Medicare only covers Skilled Nursing (rehab) for up to 100 days following a 3-day hospital stay.

Prescription Drugs

Most outpatient medications are not covered by Parts A or B.

You must buy a standalone Part D plan or a Medicare Advantage plan.

Foot Care

Routine nail trimming, corn/callus removal.

Covered for people with specific conditions like diabetes or nerve damage.

Alternative Medicine

Most acupuncture (except for chronic low back pain), massage therapy, and chiropractic "maintenance."

Some California-specific Medicare Advantage plans add these as "extra" benefits.

Foreign Travel

Healthcare received outside the U.S. and its territories.

Some Medigap plans (like Plans G or N) provide limited foreign travel emergency coverage.
  • Timing Matters

Enrollment Period

Enrollment periods in California depend on whether you are looking for Medicare or an individual/family plan through Covered California.

Medicare Enrollment (Age 65+ or Disability)

For those eligible for Medicare, there are several key windows throughout the year:

  • October 15 – December 7

Annual Enrollment Period (AEP)

This is the main time to join, switch, or drop a Medicare Advantage or Part D prescription drug plan. Changes take effect on January 1.
  • January 1 – March 31

Medicare Advantage Open Enrollment

If you are already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare during this time.

  • 7-month window

Initial Enrollment Period (IEP)

Around your 65th birthday (3 months before, your birth month, and 3 months after).

  • January 1 – March 31

General Enrollment Period (GEP)

For those who missed their Initial Enrollment. Late enrollment penalties may apply.

Special Enrollment Periods (SEP)

You can often enroll outside of these dates if you experience a qualifying life event, such as:

  • Losing job-based health coverage.
  • Moving to a new area.
  • Getting married or having a baby.
  • Losing Medi-Cal eligibility.

Medi-Cal

(California's Medicaid program) does not have a specific enrollment period; you can apply year-round if you meet the income requirements.

Medi-Cal covers low-income individuals and families, including:

  • Low-income adults
  • Pregnant women
  • Children in low-income households
  • Seniors and persons with disabilities