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, 2025 Change your Medicare health or drug coverage for 2026, if you decide to. 

January 1 to March 31, 2026 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 2025, Medicare requires the following out-of-pocket inpatient hospital costs:

• Deductible of $1,676 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 $419 per day for days 61-90 (after you have been in the hospital for 60 days)
• Copayment of $838 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 2025 is $185. 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 $257. 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 2025: 

Single person - Yearly income -less than $23,475  and Other resources less than $17,600.

Married person living with a spouse and no other dependents - Yearly income less than $31,725   and Other resources less than $35,130

The state of California has made it easier for Californians to apply for help paying Medicare costs. 

Starting January 1, 2024, the asset test to qualify for a Medicare Savings Program was eliminated. This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles. Individuals still have to meet income requirements for these programs. 

Starting January 1, 2025, California will become a Medicare Part A Buy-In State. As a result, eligible full-scope Medi-Cal members who are enrolled in Medicare Part B and qualify for one of the MSP programs called the Qualified Medicare Beneficiary (QMB) program will be automatically enrolled in Medicare Part A Buy-In by the state. The state will cover Medicare Part A premiums for these Medi-Cal members. 

You can also visit the DHCS Medicare Premium Payment webpage to learn more.

1. Qualified Medicare Beneficiary (QMB)

Payment of Medicare Part A and Part B Premium, Deductibles and Copayments

How to Qualify

To qualify for QMB, your monthly income cannot exceed $1,305 if you are single ($15,650/year) or $1,763 ($21,150/year) if you are part of a couple.

2. Specified Low-Income Medicare Beneficiary (SLMB)

Payment of Medicare Part B Premium 

How to Qualify

To qualify for SLMB, your monthly income cannot exceed $1,566 if you are single ($18,780/yr.) or $2,116 ($25,380/yr.) if you part of are a couple.

3. Qualified Individual (QI)

Payment of Medicare Part B Premium 

How to Qualify

To qualify for QI, your monthly income cannot exceed $1,762 if you are single ($21,128/yr.) or $2,381 ($28,553/yr.) if you are part of a couple.

4. Qualified Disabled Working Individual (QDWI)

Payment of Medicare Part A Premium 

How to Qualify

To qualify for QDWI, your monthly income cannot exceed $2,610 if you are single ($31,300/yr)  or $3,526 ($42,300) if you are part of a couple in 2025.

5. How to Apply

The application process for Medicare Savings Programs is the same as Medi-Cal. If you are eligible, you can tell your county eligibility office which program you would like to enroll in. Apply for a Medicare Savings Program, and Medi-Cal, in one of the following ways:

• Online at BenefitsCal.org. 
  
• By mail. You can download a Medi-Cal application (also includes Medicare Savings Programs) in many languages here. 
  
• By phone. To apply by phone, call your local county social service office. You can find the phone number to your local county office here.
  
• In Person. You can apply for Medicare Savings Programs or Medi-Cal coverage in person at your local county social service office. You can find your local county office here, or by calling the Medi-Cal Helpline at (800) 541-5555.
  

If you only want to apply for a Medicare Savings Program, you may fill out the application (MCA 14) and mail it to the Medicare Savings Program contact at your local county office. You may also apply by phone with your local county social service office. 

For more general information about Medicare Savings Programs, visit Medicare.gov. 

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.

PACE

Program of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community for as long as possible instead of going to a nursing home or other care facility.

If you join PACE, a team of health care professionals will work with you to help coordinate your care.

How does PACE work?

PACE covers all Medicare- and Medicaid-covered care and services, and anything else the health care professionals in your PACE team decide you need to improve and maintain your health. This includes prescription drugs and any medically necessary care. The team personalizes your care based on your medical, physical, social, and emotional needs and preferences.

Here are some of the services PACE may cover:

• Adult day primary care (including doctor and recreational therapy nursing services)
• Dentistry
• Emergency services
• Home care
• Hospital care
• Laboratory/x-ray services
• Meals
• Nursing home care
• Nutritional counseling
• Occupational therapy
• Physical therapy
• Preventive care
• Social work counseling
• Transportation to the PACE center for activities or medical appointments

You’ll get your Part-D covered drugs and all other necessary medication from the PACE program. If you join a separate Medicare drug plan while you’re in the PACE program, you’ll be disenrolled from PACE.