Medicare Advantage in California

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California Medicare Advantage enrollment by the numbers

With more than 2.3 million enrollees, there were more Medicare Advantage beneficiaries in California as of 2017 than in any other state in the U.S.¹

There are several major types of Medicare Advantage plans. In the state of California, there are 186 different Medicare Advantage plans available as of 2018, which is the most of any state.² Not every plan is available in each county, so it's important to find out which ones are offered where you live.

HMO plans dominate in California, with around 95 percent of all Medicare Advantage enrollees in the state being enrolled in this type of plan. The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans. These plans each make up less than 1 percent of all MA plans sold in California.

Total number of Medicare Advantage enrollees in California: 2,348,224 as of 2017¹

California's Medicare Advantage enrollees by plan type:

Plan type Percentage of California enrollees (2017)
HMO 95%
Local PPO 5%
Regional PPO 0%
PPFS <1%
Cost Plans <1%
Other Plans <1%

Data reflects Medicare Advantage enrollment in the state of California as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

California Health Insurance Counseling and Advocacy Program (HICAP)

California’s Health Insurance Counseling and Advocacy Program (HICAP) provides free education, counseling and outreach for the state’s Medicare beneficiaries. You may contact California’s HICAP at 800-434-0222 with any questions about Medicare benefits, prescription drug coverage, Medicare Advantage plans, Medicare Supplement Insurance, long-term care insurance and more.    

You can also explore more information about the insurance industry in California by visiting the state’s Department of Insurance website.

 

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.

TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Medicare has neither reviewed nor endorsed this information.

Last Updated: 4/24/2018