California Senior Health Insurance: What Is It and Do You Qualify?

For most American seniors, including those living in California, senior health insurance usually means Medicare. And because our seniors here in Sonoma County, as in all of California, want affordable, quality healthcare, it’s important to understand the costs and benefits that come with Medicare.

According to some projections, by 2030 more than nine million Californians will be over the age of 65, which is three million more than there was in 2019 when those numbers were tallied.

It’s been estimated that in less than seven years, more than 20 percent of the state’s population will be seniors. In fact, according to data from the U.S. Census Bureau and the California Department of Finance, as of 2019, the California population aged 65 and up had reached 5,835,000 Baby Boomers and those who came before.

The massive Baby Boomer generation is defined by the U.S. Census Bureau as the generation born between 1946 and 1964. All of which simply means that California will see approximately three million more seniors will be enrolled in Medicare, the primary California health insurance for seniors.

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So, What is Medicare Exactly? A Brief Explanation

Given the general tenor and background of most Baby Boomers, they can’t really be blamed for not paying much attention to things like Social Security pensions and Medicare. That’s for older people and, besides, Baby Boomers are the generation of eternal youth and perpetual adolescence according to some social critics.

But the reality is that Baby Boomers are those “older people” now and in less than eight years, they will all be 65 and older. And it’s at the start of those three months prior to turning 65 that a seven-month long open enrollment period begins for Medicare.

Definitely, something to watch for!

What you should know:

Medicare is a national health insurance program in the United States administered by the Centers for Medicare and Medicaid Services (CMS).

It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Medicare covers about half of the healthcare expenses of those enrolled. Medicare recipients almost always cover most of the remaining costs by taking additional private insurance and/or by joining a public Part C or Part D Medicare health plan.

Do You Qualify for Medicare?

In general, all persons 65 years of age or older who have been legal residents of the United States for at least five years are eligible for Medicare. People with disabilities under 65 may also be eligible if they receive Social Security Disability Insurance (SSDI) benefits.

Specific medical conditions may also help people become eligible to enroll in Medicare.

People qualify for Medicare coverage, and Medicare Part A premiums are entirely waived, if one of the following circumstances apply:

They are 65 years or older andUS citizens or have been permanent legal residents for five continuous years, and they or their spouses (or qualifying ex-spouses) have paid Medicare taxes for at least 10 years.

They are under 65, disabled, and have been receiving either Social Security SSDI benefits or Railroad Retirement Board disability benefits; they must receive one of these benefits for at least 24 months from the date of entitlement (eligibility for first disability payment) before becoming eligible to enroll in Medicare.

They get continuing dialysis for end-stage renal disease or need a kidney transplant.

The official website for Medicare notes that,

“The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.”

The Parts of Medicare

What you need to know:

Medicare is divided into four parts: A, B, C, and D.

When you sign up, Social Security enrolls you in what is known as Original Medicare (Part A and Part B).

Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
Medicare Part B (medical insurance) covers outpatient services including services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services, and most professionally administered prescription drugs.

The other parts of Medicare are purchased from and administered by private insurance companies that follow rules set by Medicare.

Medicare Advantage Plan (previously known as Medicare Part C) is an alternative that allows patients to choose health plans with at least the same service coverage as Parts A and B, often the benefits of Part D, and always an annual out-of-pocket expense limit which A and B both lack. A beneficiary must enroll in Parts A and B first before signing up for Part C.

Medicare Part D (Medicare prescription drug coverage) helps cover the cost of most prescription drugs.

In addition, Medicare enrollees can purchase what is known as Supplemental (Medigap) policies to help pay Medicare for out-of-pocket copayments, coinsurance, and deductible expenses.

Some other options to be aware of:

Most people aged 65 or older are eligible for free Medicare hospital insurance (Medicare Part A) if they have worked and paid Medicare taxes long enough.

You can enroll in Medicare medical insurance (Medicare Part B) by paying a monthly premium. Because you must pay a premium for Part B coverage, you can turn it down.

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll.

J.C. Lewis: Your Resource for Medicare and California Senior Health Insurance Needs

J.C. Lewis Insurance is located in Santa Rosa in picturesque Sonoma County and offers California senior health insurance plans only from leading health insurance carriers licensed to do business in California.

In addition to being expert California health insurance agents and brokers, we are licensed and certified by each insurance carrier to offer coverage to individuals, families, small group employers, and to seniors for Medicare supplemental and prescription drug plans.

If you are currently working and your employer doesn’t provide health benefits, an individual or family plan may be the best option for you and your spouse. If you’re retired and soon to be 65, you are most likely eligible for Medicare.

After you enroll in Medicare, be sure to take advantage of the one-time “Welcome to Medicare” preventive visit.

This comprehensive visit comes at no cost to you and helps you plan for a healthy future. To prepare for your visit be sure to bring your medical and immunization records, as well as information about your family’s health history and a list of your current prescription medications.

For help in finding the right California Medicare health or prescription drug plan and finding Medicare providers in your area, give J.C. Lewis Insurance Services a call toll-free at 866-745-9555.

We’ll help you understand your options so you can make an informed decision

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