NOTE: If you are new to Medicare it is important to select appropriate additional coverage.
Links to the following topics on this page:
Important Timing Issues for different enrollment periods
About Medicare Advantage Plans (MAPD)
About Medigap (Medicare Supplement) Policies
About Prescription Drug Plans (PDP)
Important Timing Issues:
- It’s important to make decisions about your Medicare coverage on time. You can choose a plan during your initial enrollment period or during a special enrollment period, if you qualify for one. If you do not enroll in a Prescription Drug Plan or a Medicare Advantage Plan, your coverage will default to Original Medicare without Part D prescription drug coverage. In that case, you may need to wait until the fall open enrollment period to sign up for a plan, and your coverage would not begin until January of the following year.
- If you have Original Medicare you generally will have a 6-month open enrollment period after you are first enrolled in Medicare Part B to purchase a Medigap policy (Medicare supplement.)
- If you qualify, you can join a Chronic Special Needs Medicare Advantage Plan at any time. These plans are only for people who have specific chronic conditions.
- If you don’t have prescription drug coverage you may be subject to a Part D late enrollment penalty.
Avoid problems. Here is a list of HICAP counseling locations throughout Contra Costa County with phone numbers and make an appointment for one-on-one counseling.
Medicare Plans
Medicare Advantage Plans with Prescription Drug Coverage
Medicare Advantage (MA) plans are private insurance plans that are approved and funded by Medicare. They provide the same basic benefits as Original Medicare and offer an alternative way to receive your Medicare coverage. When you enroll in a Medicare Advantage plan, you may not use the plan’s card outside of that plan. Before choosing a Medicare Advantage plan, it’s important to make sure your doctors, medical groups, hospitals, and prescription medications are included in the plan’s network and coverage.
Unless you are in your initial Medicare enrollment period or qualify for a special enrollment period, you can only enroll in a plan during the annual fall Open Enrollment period, which runs from October 15 through December 7. The only exception is enrollment in a 5-Star Plan; however, there are currently no 5-Star Plans available in Contra Costa County.
In most cases, you can only leave a plan during the fall Open Enrollment period. However, Medicare also offers a Medicare Advantage Open Enrollment period each year from January 1 through March 31. During this time, you can switch back to Original Medicare and enroll in a stand-alone Prescription Drug Plan. If you are already enrolled in a Medicare Advantage plan, you may also make a one-time change to a different Medicare Advantage plan during this special enrollment period.
Read about the Medicare Advantage plans offered this year.
Specialized Medicare Advantage Plans, most with Prescription Drug Coverage
There are specialized Medicare Advantage Plans available for those who meet specific criteria. Some of these plans have different rules for enrollment. These specialized plans include:
Plans for Full Duals (offered only for persons who have Medicare and full scope Medi-Cal)
Chronic Conditions Plans for people with certain chronic conditions such as diabetes, COPD, heart disease, etc.
Premium Reduction Plans for people who are covered under non-Medicare insurance (such as VA).
Medigap (Medicare Supplement) Policies
Medigap (also called Medicare Supplement) policies are private insurance plans that help cover medical costs Medicare does not pay, such as deductibles and coinsurance. Medicare first pays its share of the Medicare-approved amount, and then the Medigap policy pays its portion. Medigap plans are labeled by letters (A through N), and all plans with the same letter provide the same level of coverage. Some Medigap plans cover all deductibles and coinsurance costs.
There are separate Medigap policies for those 65 and older and those who are under 65 and on Medicare due to disability.
Read detailed information about Medigap policies here.
Stand-Alone Prescription Drug Plans
Stand-Alone Prescription Drug Plans are normally for those who do not enroll in a Medicare Advantage Plan. That includes those who elect to use just Original Medicare or who also select a Medigap Policy.
Read more about Stand-Alone Prescription Drug Plans here.