California Medigap Insurance: How Does It Work?

California Medicare Supplements are designed to fill in the “gaps” in Medicare so that you have few (or in some cases, no) out of pocket costs. Altogether, there are 10 different plans, each sold through private insurers. All of these plans “supplement” Medicare. Most importantly, all Medicare Supplement plans are Federally-standardized. What this means is that each company is required to offer the same coverage plans. This makes it easy to compare “like” plans. You can view the standardized coverage chart here Medigap coverage chart.

Although there are 10 different plans offered, there are a few of the plans that are significantly more prominent than others: Medigap Plan F, Plan G, and Plan N are the most common plans (and the plans offered by most insurance companies – not all companies offer all plans). Regardless of which plan you choose, some or all of the gaps in Medicare are accounted for so that your out of pocket costs are minimized, or in some cases, eliminated completely. Medigap Plan F is the most comprehensive option and is often viewed as the most advantageous – it pays both Medicare deductibles (Medicare Part A and Medicare Part B), as well as the 20% that Medicare itself doesn’t cover at the doctor and hospital. However, although Plan F is the most comprehensive, Plan G, depending on the premium where you live, can sometimes be a better option and a better value.

No matter which company you purchase your plan from, it will work in the exact same way:

  • There are no networks with Medigap plans. What this means for you is that any doctor that takes Medicare, nationwide, is required to take the Medigap plans, regardless of company. Because the plans are national, coverage is the same in your home state/area or anywhere else in the country. So, buying a plan because your doctor says he is familiar with it may make you feel better about it, but is not important to do. If the doctor takes Medicare, he or she must take any of the standardized Medigap plans.
  • Secondly, unlike on some types of individual insurance, you do not have to file/pay claims yourself. Everything regarding this is automated through the Medicare “crossover” system. This system ensures timely payment of the claims, no matter which company is insuring you.

California Medigap Comparison

Because there are three significant things that are the same with all companies – coverage, doctor acceptance, and claims payments – the two aspects that we recommend comparing when looking at a Medigap insurance are: price and company reputation. These are the factors that are essential to choosing between the various Medigap plan options and companies. These two factors can be vastly different from one company to the next. While one company may charge $200 for their top-level Plan (Plan F), you may be able to get the same plan for $125/month elsewhere. Because coverage, claim payments and doctor acceptance is the same, the lower-priced company is always the sound financial decision.

As far as comparing the plans, it would be nearly impossible on your own to contact all 40+ companies that offer Medicare Supplements in California (and many companies don’t give rates over the phone, only in person). However, you can easily obtain a chart showing rates from an independent brokerage/agent, typically by email. This allows you to compare all of the plans in a centralized, unbiased place. An independent agent can also give you information about plan customer service, rate increase history, and other factors that you are not able to obtain from the companies themselves.

Medicare-Supplement.US can help you compare plans by providing a customized rate quote analysis by email. This allows you to see rates and company ratings in a centralized place and will greatly assist in your understanding of the options. To have a rate quote analysis emailed to you, just request a California Medigap quote.

California State-Specific Medigap Implications

As we’ve discussed, Medicare Supplement plans are Federally-standardized. So, California plan designs are the same as plans in other states. However, there are some state-specific guidelines, etc. that do impact Medigap plans here:

  • First of all, California has a very unique rule called the “California birthday rule“. This rule enables you an annual open enrollment period for Medicare Supplements (in most states, you do not have this period annually, only when you first go on Medicare). The “birthday rule” stipulates that within 30 days of your birthday, you can choose a policy from another company with equal or lesser benefits WITHOUT medical underwriting. So, for example, if you have a Plan F, you can annually choose any other plan (since plan F is considered the most comprehensive) from any company.
  • California DOES use tobacco usage as an underwriting criteria when you are turning 65 or in open enrollment or “guaranteed issue” period (some states do not). There are no underwriting limitations, or higher rates, based on any pre-existing conditions or factors like tobacco use, when you are in open enrollment or “guaranteed issue”.
  • The vast majority of companies that sell Medicare Supplements in California do not have gender-specific rates. When they do, female rates are typically 5-10% lower than the male rates.
  • California Medicare Supplements do permit household discounts to be applied on the plans. This is something to consider, if you are applying with a Medicare-eligible spouse. There are some companies (Mutual of Omaha, Family Life, to name a few) that do offer household discounts. These discounts can make an appreciable difference when comparing to the premiums of a company that does not offer the discount. This can definitely mean the difference in one company over another when comparing costs.

How to Get a California Medigap Plan

Getting a California Medicare Supplement plan lined up is easy to do. In particular, if you are in a special enrollment period, such as open enrollment (turning 65 or signing up for Medicare Part B OR in the birthday rule open enrollment period mentioned above) or “guaranteed issue” (losing employer coverage, losing Advantage plan coverage, moving to a new state, etc.), you do not even need to answer medical questions or go through medical underwriting. In this case, you just simply need to complete an application and wait for your insurance cards in the mail.

If you are ready to sign up for a plan, simply compare the options, including rates and company ratings, select a plan and sign up. To get a rate quote comparison from us, which will include the top-priced options for your age and zip code and company ratings, simply request the information online using: California Medicare Supplement Quotes. We can provide the information you are seeking so you can compare multiple quotes in a centralized place and make an informed decision.

California Medigap: Top-Priced Companies Available Here

NOTE: There are upwards of 30 companies that do Medigap insurance in California; however, these are the ones that are competitively-priced and highly-rated currently.