Medicare Plan Information
Understanding your Medicare choices is the first step toward confident, informed decisions about your health and your future. Steve and Cindy help California residents compare the main ways to get Medicare coverage.
Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans provide all Medicare Part A and Part B benefits and may include additional benefits such as prescription drug coverage, dental, vision, hearing, fitness programs and more.
Types of Medicare Advantage Plans
Medicare Advantage Plans (HMO / PPO)
An all-in-one alternative to Original Medicare that often includes prescription drug coverage and additional benefits like dental, vision, and hearing.
Special Needs Plans (SNP)
A plan designed for people with specific chronic conditions or other qualifying healthcare needs.
Dual Eligible Special Needs Plans (D-SNP)
Designed for individuals who qualify for both Medicare and Medicaid, providing coordinated care and additional benefits.
Important Information
To enroll in a Medicare Advantage Plan, you must:
- Be enrolled in Medicare Part A and Part B
- Continue paying your Medicare Part B premium
- Live within the plan’s service area
Many Medicare Advantage plans have provider networks and may require you to use certain doctors, specialists, hospitals and pharmacies.
When Can I Enroll?
Initial Enrollment Period (IEP)
You may enroll beginning three months before the month you turn 65 through three months after your birthday month. Example: if your birthday is May 5, your IEP runs February 1 through August 31.
Annual Enrollment Period (AEP)
October 15 to December 7 each year. During this period you may join a Medicare Advantage Plan, switch plans, or return to Original Medicare.
Enrollment periods and eligibility rules are determined by Medicare and may change.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, commonly called Medigap, is sold by private insurance companies and works alongside Original Medicare. Medigap policies may help pay certain out-of-pocket costs such as deductibles, coinsurance and copayments. Unlike Medicare Advantage plans, Medigap policies supplement Original Medicare rather than replace it.
Important Things to Know
- You must have Medicare Part A and Part B
- You pay a separate monthly premium for your Medigap policy
- Policies cover one individual only
- Plans are standardized in most states
- Policies are guaranteed renewable as long as premiums are paid
Prescription Drug Coverage
Medigap policies sold after January 1, 2006 do not include prescription drug coverage. If you need prescription drug coverage, you may enroll in a standalone Medicare Part D Prescription Drug Plan.
Medicare Part D Prescription Drug Plans
Medicare Part D helps cover the cost of prescription medications through plans offered by private insurance companies approved by Medicare.
Why Part D matters. Enrolling when first eligible may help you avoid future late-enrollment penalties if you do not have other creditable prescription drug coverage.
2026 Part D Highlights
Annual Deductible
Up to $615 depending on plan design.
Initial Coverage Phase
After meeting the deductible, you generally pay a portion of your prescription drug costs based on your plan’s cost-sharing structure.
Annual Out-of-Pocket Cap
Beginning in 2026, covered prescription drug expenses are capped at approximately $2,100. Once the cap is reached, no additional cost-sharing is required for covered Part D medications for the rest of the year.
Medicare-Medicaid Coordinated Plans
Some individuals qualify for both Medicare and Medicaid, often referred to as dual-eligible beneficiaries. Certain plans may coordinate benefits through a single plan and care management system.
Who May Qualify?
You may qualify if:
- You are eligible for Medicare
- You qualify for Medicaid through your state
View the FPL Income Guidelines to See if You May Qualify → (opens in a new tab)
Eligibility requirements vary.
Not sure which path fits you?
Medicare Advantage, Medigap, Part D or a coordinated plan, there is no single right answer. Steve and Cindy Gordon will walk you through the options in plain language, at no cost, so you can choose with confidence.
