California Medicare questions, answered plainly

Nothing. Independent Medicare agents are paid by the insurance carriers when you enroll, so comparing plans, answering questions and reviewing your coverage each year is free to you. Your premium is the same whether you enroll through us, another agent or the carrier directly.

Each year, for 60 days beginning on your birthday, anyone who already holds a Medigap policy can switch to any insurer’s plan with the same or lesser benefits, with no medical underwriting and no new waiting period. It is why Californians should re-shop their supplement every year, and we do it for our clients before every birthday.

Yes, through Kaiser Permanente Senior Advantage, a Medicare Advantage plan. You cannot keep Kaiser doctors with Original Medicare and a Medigap policy, because Kaiser does not generally treat Original Medicare patients outside emergencies. Our Kaiser page compares the two paths honestly.

You get a Special Enrollment Period to choose a new plan and, because you lost coverage through no fault of your own, generally a guaranteed-issue right to buy a Medigap policy without health questions, usually within 63 days of the coverage ending. Anthem’s PPO exit and Aetna’s county cuts for 2026 both qualify. Call before the deadline on your notice.

Most non-Kaiser Advantage plans in California delegate your care to a physician group tied to your primary doctor. That group approves referrals and decides which specialists and hospitals you can use. Two people on the same plan can have different access; checking the group is as important as checking the plan.

Yes. California requires insurers to offer Medigap to people under 65 on Medicare because of disability, with a six-month open enrollment when Part B begins. Premiums for under-65 policies are higher, and the requirement does not extend to people under 65 with ESRD. You get a fresh open enrollment for every plan at 65.

All three accept Original Medicare and therefore every Medigap policy. Each contracts with some Medicare Advantage plans and medical groups and not others, and the lists change yearly. If one of them, or City of Hope or UCSF, is your care, we confirm the plan’s and the group’s status in writing before you enroll.

Partly. CalPERS requires you to enroll in Medicare Parts A and B when eligible and move into a CalPERS Medicare plan to keep CalPERS coverage; many State and CSU retirees get Part B reimbursed. Those plans are separate from the individual-market plans we sell, but we can still explain Medicare, Part B timing and IRMAA plainly.

Original Medicare and a Medigap policy do, re-rated for the new state; an Advantage or Part D plan does not, and the move opens a Special Enrollment Period. California’s birthday rule does not travel. Our sister agencies in Arizona, Nevada, Texas, Utah, Colorado and Florida can take it from there.

Usually not. A FEMA-declared disaster opens a Special Enrollment Period for people who lived in a declared county, or who rely on someone who did, and missed a valid election period because of it. Part D plans must also allow early refills in the emergency area. Our Wildfires page has the details.

Usually neither. TFL pays secondary to Medicare and its pharmacy is creditable Part D coverage. You do need Part B, and you must keep it. Our Veterans page covers the exceptions.

In most cases, yes. VA medical care is not creditable coverage for Part B, so delaying Part B adds a lifelong penalty, and VA care does not cover you at non-VA hospitals in an emergency. Most California veterans keep both.

Your Initial Enrollment Period is the seven months around your 65th birthday. The Annual Election Period is October 15 to December 7, and Medicare Advantage Open Enrollment runs January 1 to March 31. Moving, losing a plan, a disaster declaration, or qualifying for Medi-Cal or Extra Help each open a Special Enrollment Period, and the birthday rule covers Medigap switches every year.

Part B premium $202.90 a month, Part B deductible $283, Part A hospital deductible $1,736 per benefit period, Part D out-of-pocket cap $2,100, maximum Part D deductible $615. IRMAA surcharges begin at $109,000 of modified adjusted gross income for a single filer and $218,000 for a joint return, looking back two tax years. See our costs page for the full table.

Possibly. California’s Medicare Savings Programs (QMB, SLMB and QI) pay the Part B premium for people with limited income and resources, and QMB also covers Medicare’s deductibles and copays. Apply through your county Medi-Cal office or BenefitsCal; HICAP (1-800-434-0222) can help. An asset limit of $130,000 for one person returned on January 1, 2026.

An exclusively aligned Dual Special Needs Plan: a Medicare Advantage plan run by the same organization as your Medi-Cal managed-care plan, so both programs are coordinated by one care team. Available in 41 counties for 2026 under CalAIM.

HICAP, the Health Insurance Counseling and Advocacy Program, California’s State Health Insurance Assistance Program, run by the Department of Aging through local Area Agencies on Aging: 1-800-434-0222. It is free and independent, and we point people to it.

No. We represent a number of insurance organizations and products in California, not all of them. For a complete list, use Medicare.gov, 1-800-MEDICARE or HICAP.

Darin Weidauer holds California insurance license #0M00978 (NPN 18580338). You can verify it through the California Department of Insurance license lookup at insurance.ca.gov, or through the NIPR.

We work with Californians statewide by phone and video, which is how most people prefer it across a state this size. If you are in Arizona for part of the year, our sister agency has offices in Mesa and Sun City.