Health Coverage (2024)

Senior Health Coverage

As a senior, you have many options to choose from for your health coverage. This section pulls together senior health related information all in one convenient location for you. The various senior health coverage options listed below describe some of their differences and offer links to resources for you. You should consider your personal needs and finances before making any choice.

The California Department of Insurance (CDI) regulates health plans underwritten by insurance companies. That means that some of your options, like Medicare, are not regulated by CDI and you will have to contact another agency if you need help with a problem or need assistance. We have listed contact information for each option, below.

Medicare

Medicare is a federally funded insurance program for eligible participants 65 or over. Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare does not cover 100% of all costs. CDI recommends purchasing a Medicare Supplement Insurance policy if you have traditional Medicare to help offset your health care costs. If you have questions related to Medicare, contact Medicare or your local Department of Aging (HICAP).

Medicare Part D

(Prescription Drug Coverage)

Medicare Part D is a voluntary prescription drug program for Medicare beneficiaries. Prescription drug plans are sold by private companies but must be approved by Medicare. Before you purchase a prescription drug plan, it is important to make sure the one you are considering is approved by Medicare. Drug plans can have rules about what drugs are covered in different drug categories, so you should also make sure the plan you are considering covers any brand name drugs you are currently taking and wish to continue.

Information on Medicare Drug Plans can be found at Medicare's official website for Prescription Drug Coverage.

Additional information on Medicare Part D can be found at:

A non-profit organization sponsored by the National Council on Aging

This is a Medicare Part D program to assist certain low income individuals with the cost of prescription drug coverage.

Medicare Supplement Insurance

To purchase Medicare Supplement Insurance you must be enrolled in Medicare Part A and Part B. Medicare Supplement Insurance (also known as Medigap) provides coverage for gaps in medical costs not covered by Medicare. Medicare Supplement plans are standardized and offer various benefits to help offset your healthcare cost.

The California Department of Insurance (CDI) regulates Medicare Supplement policies underwritten by licensed insurance companies. The CDI assists consumers in resolving complaints and disputes concerning premium rates, claims handling, and many other problems with agents or companies. The Consumer Hotline 800-927-4357 is serviced by experienced professionals who will answer your questions, or assist you in filing a complaint.

To find information on Medicare Supplement Insurance, the names of companies authorized to sell it and compare premiums, please visit our Guide to Medicare Supplement page.

Medicare Advantage

Medicare Advantage is an alternative to traditional Medicare Part A and Part B. Medicare Advantage Plans are approved by Medicare, but are run by private companies that include Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). If you have questions related to Medicare Advantage Plans, contact Medicare at 1-800-633-4227.

Medicare's official U.S. Government website

Additional information on Medicare Advantage Plans can be found at:

Medi-Cal

Medi-Cal is California's Medicaid program that provides health insurance for low-income individuals and families. Visit our Public Programs page for more information or the California Department of Health Care Services.

Health Coverage (2024)

FAQs

What is the meaning of health coverage? ›

Legal entitlement to payment or reimbursem*nt for your health care costs, generally under a contract with a health insurance company, a group health plan offered in connection with employment, or a government program like Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).

What is the best health insurance in California? ›

Kaiser Permanente is the best health insurance company in California. Kaiser Permanente has the highest quality and satisfaction rating possible, according to Covered California. In most of California, Kaiser isn't the cheapest option.

How to get free healthcare in California? ›

Who is eligible? Qualify for Medi-Cal if your income is up to 138 percent of the Federal Poverty Level (FPL) for adults, and up to 266 percent FPL for children. Check Shop and Compare to see if you qualify. Learn more on the Department of Health Care Services website.

Who qualifies for Covered California? ›

Any Californian can get health insurance through Covered California if he or she is a state resident and cannot get affordable health insurance through a job.

What is the difference between health coverage and health insurance? ›

Health insurance, also known as Health Insurance Coverage, is the instrument that reimburses patients for their healthcare needs. It's normally used to cover medical expenses due to illnesses, which can mean hospitalization, medicine, and health care professional visits.

What is the difference between health care and health coverage? ›

Healthcare and health insurance are terms that are often used interchangeably. However, healthcare, which typically includes elements like emergency room visits, preventative medicine, and prescription drugs, is far different than health insurance which provides coverage for medical services.

How much is health insurance a month for a single person in California? ›

Average Monthly Health Insurance Premiums for Benchmark Plans by State Without Premium Tax Credits
Location2023Percent Change
California$4328%
Colorado$38019%
Connecticut$6275%
Delaware$549-3%
49 more rows
Mar 14, 2024

What are the top 3 health insurances? ›

Best Health Insurance Companies for 2024
  • Best Overall: Blue Cross Blue Shield.
  • Highest Quality Plans: Kaiser Permanente.
  • Most Health Management Programs: Oscar.
  • Best for Same-Day Care: Aetna CVS Health.

Can I buy my own health insurance in California? ›

Buying Individual Health Insurance on Your Own

You can buy an individual policy from an insurance company, a licensed health insurance agent, or from Covered California- California's Healthcare Marketplace.

Can you go without health insurance in California? ›

Most people in California are required to have health coverage. If you do not have health coverage you may have to pay a tax penalty. This is called the “individual mandate.”

What is the income limit for Medi-Cal California? ›

You are 19-64 years old and your family's income is at or below 138% of the Federal Poverty Level (FPL) ($20,783 for an individual; $43,056 for a family of four). You are a child 18 or younger and your family's income is at or below 266% of FPL ($82,992 per year for a family of four).

Do you have to pay if you don t have health insurance in California? ›

California is one of four states, plus the District of Columbia, that penalizes residents for not having health insurance. This tax season, Californians are seeing health insurance penalties of up to $850 per adult and $425 per child.

What income disqualifies you from Covered California? ›

The limits are based on both household income and household size. In 2024, an individual in a one-person household is eligible for some degree of Covered California subsidies if they earn up to $33,975 Meanwhile, that limit rises to $69,375 for a household size of 4.

Can you join Covered California at any time? ›

Open enrollment for Covered California starts in the fall. Even when open enrollment is over, individuals with qualifying life events can enroll at any time of the year. Medi-Cal enrollment is also year-round.

What income does Covered California look at? ›

According to Covered California's official guidelines, “Your Modified Adjusted Gross Income is your Adjusted Gross Income (found on your tax return) plus any tax-exempt Social Security, tax-exempt interest, and tax-exempt foreign income you have.”

What is coverage in insurance? ›

What is Insurance Coverage? Insurance coverage is the amount of risk, liability, or potential loss that is protected by insurance. It helps individuals recover from financial losses as a result of incidents, such as car accidents, damaged property, or unexpected health issues.

What are health benefits in insurance? ›

These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services. Plans must offer dental coverage for children.

What are the two main sources of health insurance? ›

Three primary sources of medical insurance plans are employer-sponsored plans, government programs, and individual policies.

What are the two main sources of health insurance coverage in the United States? ›

Employment-based: Plan provided through an employer or union. Direct-purchase: Coverage purchased directly from an insurance company, or through a federal or state Marketplace (e.g., healthcare.gov).

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