Resources for California beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In California you can reach SHIP at 1-800-434-0222 or online here.
Snapshot of Medicare in California
Total Medicare enrollment in The Golden State
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 23 percent each. Those with the lowest percentage are Alaska (11 percent) and Utah (12 percent). In raw numbers, Alaska has the fewest Medicare enrollees at 83,863 and California has the most. This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,075 Medicare enrollees in 2015).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 86 percent of California Medicare enrollees. The balance — 14 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (25 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 10 percent, followed by New Jersey, and North and South Dakota at 13 percent each.
Medicare spending per recipient
As of 2014, Medicare paid about $8,598 annually per enrollee in Colorado. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas like Alaska). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
Medicare spending overall
With the largest and smallest numbers of recipients, itʼs no surprise that California‘s total Medicare spending was the highest of all the states, while Medicare spending in Alaska was only $553 million.
Medigap in California
Medigap is the only form of private coverage for Medicare beneficiaries that has no federally-mandated annual open enrollment period. Medigap plans are guaranteed issue during a six month window that starts when you turn 65 and enroll in Original Medicare. During that time, enrollees can purchase any Medigap plan available in their area, with no medical underwriting.
But once that enrollment period ends, seniors often find themselves unable to switch plans, because in most states, purchasing a new plan can be impossible or prohibitively expensive due to medical underwriting (under federal guidelines, there are seven limited circumstances when you can get a new Medigap plan without medical underwriting).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have passed laws that make it easier for seniors to switch from one Medigap plan to another. California implemented a “birthday rule” in 2010 that grants seniors – who are already enrolled in a Medigap plan – the right to switch to any other Medigap plan with equal or lesser benefits, during a 30 day window following their birthday each year.
California also allows disabled, under-65 Medicare beneficiaries (except those with end-stage renal disease) to enroll in certain Medigap plans with no medical underwriting during a six month window after they enroll in Medicare Part B.
Medicare Advantage in California
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
More than 5.6 million California residents were enrolled in Medicare in 2015, and 38 percent of them had selected Medicare Advantage plans. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.
Minnesota is the only state where more than half (53 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska is the only state to have zero percent enrolled in Medicare Advantage, although five states have Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire and Vermont with 7 percent, and Delaware and Maryland with 8 percent.
Stand-alone Medicare Prescription Drug plans
California had 2,049,217 Medicare beneficiaries – more than 36 percent of the state’s total – enrolled in stand-alone prescription drug plans in 2015. The state has 28 plans with premiums ranging from about $18 to $132 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.
But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries nationwide, including those who have Part D coverage as part of their Medicare Advantage plan).