Taking Care of Your Family

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Plan availability varies by service area or county. Please contact Medicare.gov or 1-800-MEDICARE or the State of California Health Insurance Counseling & Advocacy Program (HICAP) to get information on all of your options. 

Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

October 15 to December 7, 2023 Change your Medicare health or drug coverage for 2024, if you decide to. 

January 1 to March 31, 2024 If you’re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. 

In most cases, if you’re enrolled in a Medicare Advantage Plan, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, like if you move or you lose other insurance coverage, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period.

With Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. 

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.  

As of 2024, Medicare requires the following out-of-pocket inpatient hospital costs:

• Deductible of $1,632 for the first day you are a hospital inpatient. This single deductible covers the next 59 days in the hospital for the same benefit period.
• Copayment of $408 per day for days 61-90 (after you have been in the hospital for 60 days)
• Copayment of $816 per day for days 91-150 (after you have been in the hospital for 90 days; these are your 60 lifetime reserve days)

Part B (Medical Insurance): Helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

The standard Medicare Part B premium for 2024 is $174.70. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). The annual deductible for all Medicare Part B beneficiaries is $240. Medicare Part B pays 80% of the costs for most outpatient care and services and you pay 20% coinsurance.

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.  

Part D (Drug coverage) Helps cover the cost of prescription drugs (including many recommended shots or vaccines). Plans that offer Medicare drug coverage (Part D) are run by private insurance companies that follow rules set by Medicare. 

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. 

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental services, hearing aids, eyeglasses, or private-duty nursing. 

Medigap must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” plan, identified in most states as plans A – D, F, G, and K – N. All plans offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap plans are standardized in a different way. If you live in one of these states and want more information, visit Medicare.gov or Medicare.gov/publications to view the booklet, “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.”

Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy Plan C or Plan F. People new to Medicare on or after January 1, 2020, have the right to buy Plans D and G instead of Plans C and F. 

If you have limited income and resources, you may qualify for help to pay for some health care and drug coverage costs. Extra Help is a program to help people with limited income and resources pay Medicare drug costs. You can apply online or call Social Security Administration at   1-800-772-1213.

You may qualify for Extra Help if your yearly income and resources are below these limits in 2023: 

Single person - Yearly income -less than $21,870  and Other resources less than $16,600.

Married person living with a spouse and no other dependents - Yearly income less than $29,580   and Other resources less than $33,240

Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program.

You must meet certain income and asset limits to qualify for these programs, which are administered by Medi-Cal (the California health program known as Medicaid in other states). 

The Qualified Medicare Beneficiary (QMB) program helps pay for the following Medicare costs:

• Medicare Part A premium. Note: Some people are required to pay a premium for Medicare Part A because they do not have enough Social Security credits. Most people do not pay a premium for Medicare Part A because they or their spouse earned enough credits by working 40 or more quarters (approx. 10 years of working full-time, four quarters per year). People who worked 30-39 quarters may buy Part A coverage and pay a monthly premium of $278 in 2023. People who worked fewer than 30 quarters may also buy Part A coverage and pay a higher monthly premium of $506 in 2023.
• Medicare Part B premium ($164.90 per month in 2023)
• Deductibles for both Part A ($1,600 per benefit period in 2023) and Part B ($226 annually in 2023)
• Coinsurance under both Part A and Part B. For example, under Part A, QMB pays the $400 per day for hospital days 61-90, and the $800 per day for the 60 hospital lifetime reserve days in 2022. Under Part B, QMB pays the remaining 20% coinsurance after Medicare pays 80% of the covered outpatient medical services such as physician visits, as long as you see doctors and other providers who accept Medi-Cal. Note: This is because Medi-Cal administers the MSPs and will only pay providers who accept Medi-Cal.

To qualify for QMB, your monthly income cannot exceed $1,235 if you are single ($14,820/year) or $1,663 ($19,956/year) if you are part of a couple.

Note: A $20 “disregard” is subtracted from your monthly income (earned or unearned). When you apply for QMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, as of July 1, 2022, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $130,000 for an individual and $195,000 for a couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

• One home
• Household goods and personal belongings
• One car
• Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

The Specified Low-Income Medicare Beneficiary (SLMB) program helps people with low income pay their Part B premiums. This premium would ordinarily be deducted from their monthly Social Security checks.

To qualify for SLMB, your monthly income cannot exceed $1,470 if you are single ($17,736/yr.) or $1,992 ($23,904/yr.) if you part of are a couple.

Note: A $20 “disregard” is subtracted from your monthly income (earned or unearned). When you apply for SLMB, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, as of July 1, 2022, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $130,000 for an individual and $195,000 for a couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

• One home
• Household goods and personal belongings
• One car
• Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

The Qualified Individual (QI) program helps people with low income pay for their Part B premiums, with a higher income limit than QMB or SLMB programs.

To qualify for QI, your monthly income cannot exceed $1,660 if you are single ($19,920/yr.) or $2,239 ($26,868/yr.) if you are part of a couple.

Note: A $20 “disregard” is subtracted from your monthly income (earned or unearned). When you apply for QI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program.

In addition, as of July 1, 2022, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $130,000 for an individual and $195,000 for a couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

• One home
• Household goods and personal belongings
• One car
• Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they returned to work and their earnings exceeded the allowable limit. QDWI pays for the Medicare Part A premium, but it doesn’t pay for Part B.

To qualify for QDWI, your monthly income cannot exceed $4,945 if you are single ($59,340/yr)  or $6,659 ($79,908) if you are part of a couple in 2023.

Note: A $20 “disregard” is subtracted from your monthly income (earned or unearned). When you apply for QDWI, your eligibility worker will automatically deduct $20 from your monthly income. For some people whose income is close to the limit, this $20 disregard allows them to qualify for the program. (The QDWI program also has an additional $65 disregard that applies when there is earned income.)

In addition, as of July 1, 2022, your personal assets (cash, money in the bank, stocks, bonds, etc.) cannot exceed $130,000 for an individual and $195,000 for a couple. Certain items are not calculated in your personal asset limit, including but not limited to the value of:

• One home
• Household goods and personal belongings
• One car
• Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot
• 
  

Retroactive Social Security or Supplemental Security Income (SSI) benefits are also excluded for 6 months after you receive them.

California offers qualifying residents the 250% California Working Disabled (CWD) program. To qualify, you must be working, disabled and have income too high to qualify for free Medi-Cal. If eligible, you may be able to receive Medi-Cal coverage by paying a small monthly premium, ranging from $20-$250 per month for an individual or from $30-$375 for a couple.

To qualify for CWD, you must:

• Meet the medical requirements of Social Security’s definition of disability
• Be working and earning income (this can be part-time work)
• Have assets worth less than $130,000 for an individual or $195,000 for a couple
• Have countable income less than 250% of the federal poverty level (in 2023, this equates to $3,038/mo. for individuals or $4,110/mo. for couples; these figures do not include the $20 disregard). These income calculations are different from those for the Medicare Savings Programs (MSPs). Disability income does not count toward the 250% CWD program’s income limit, including:
  • Social Security Disability Insurance (SSDI)
  • Worker’s compensation
  • California State Disability Insurance (CSDI)
  • Any federal, state or private disability benefits

To apply for QMB, SLMB, QI or QDWI, you must also be eligible to receive Medicare Part A and Part B. If you are already enrolled in both Medicare parts, contact your California Department of Health Care Services (DHCS) county office to apply for these programs or the 250% California Working Disabled (CWD) program. Note: Having Medicare is not required to enroll in the CWD program.

If you are eligible for Medicare but not enrolled in Part A and/or Part B, you can enroll in Part B anytime through your local Social Security Administration (SSA) office (1-800-772-1213). However, you can only enroll in Part A during a specific enrollment period. This is important if you are applying for the QMB program. For instance:

• If you just became eligible for Medicare and are in your Initial Enrollment Period (IEP), you may apply for QMB (through your DHCS county office), and Parts A and B (through the SSA).
• If you are already enrolled in Part B, and eligible but not enrolled in Part A, you may apply for QMB (through your DHCS county office) and Part A (through the SSA) during the Medicare General Enrollment Period (GEP), which is January 1 to March 31 each year.

When applying for Part A, you may state in writing that you want “Conditional Medicare” under one of the Medicare Savings Plans (MSPs). This means you only want to receive Medicare on the condition that an MSP will pay for your Medicare premiums.

Once you become eligible for Medicare, follow up with your county’s DHCS office to apply for QMB, SLMB, QI or QDWI benefits, or to verify your application status. Medi-Cal recipients don’t need to complete a new application.

To apply for the CWD program, contact your county’s DHCS office and specifically request an appointment with a coordinator authorized to work in the 250% CWD program.

Note: If you are eligible for an MSP, you are also eligible to receive “Extra Help,” also known as the Low-Income Subsidy (LIS) program, for your Part D Medicare prescription-drug costs.