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

Why is healthcare coverage important? ›

Health insurance can help protect you from the high costs of illness or injury. It also helps you get regular health care, such as exams, preventive care and vaccines.

How do I argue with health insurance? ›

Steps to Appeal a Health Insurance Claim Denial
  1. Step 1: Find Out Why Your Claim Was Denied. ...
  2. Step 2: Call Your Insurance Provider. ...
  3. Step 3: Call Your Doctor's Office. ...
  4. Step 4: Collect the Right Paperwork. ...
  5. Step 5: Submit an Internal Appeal. ...
  6. Step 6: Wait For An Answer. ...
  7. Step 7: Submit an External Review.

Why do insurance companies ask health questions? ›

However, once you're on a health plan, they can ask you questions to find out if you qualify for one of the following programs: Disease management programs: These help consumers learn how to manage chronic health conditions, such as diabetes, heart disease or depression.

What is a reasonable amount to spend on health insurance? ›

The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.

Why is it important to have coverage? ›

What are the benefits of insurance? Insurance is an important financial tool. It can help you live life with fewer worries knowing you'll receive financial assistance after a disaster or accident, helping you recover faster.

Why is healthcare the most important? ›

High-quality health care helps prevent diseases and improve quality of life.

Can you be denied coverage for a pre-existing condition? ›

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men.

Why am I forced to have health insurance? ›

California's Individual Mandate

In 2020, California became one of 5 states (plus Washington, D.C.) to implement its own individual mandate. The logic was the same as the federal individual mandate: The more people who have health insurance, the lower the cost of health insurance for everyone.

Why can insurance companies deny coverage? ›

Unfortunately, insurance companies can — and do — deny policyholders' claims on occasion. Some of the most common reasons for claim denials are exceeding the policy limit, lacking the needed coverage and breaking the law. Additionally, sometimes claims are incorrectly denied.

Is $200 a month good for health insurance? ›

Another option for affordable health insurance is a short-term plan. Plans can have rates as low as $100 to $200 per month, but coverage often has restrictions. Plans could have high deductibles or not cover prescriptions or preexisting conditions.

How much of your monthly income should go to health insurance? ›

A good rule of thumb for how much you spend on health insurance is 10% of your annual income. However, there are many factors to consider when deciding how much to spend on health insurance, including your income, age, health status, and eligibility restrictions.

What is the most expensive health insurance? ›

Platinum health insurance is the most expensive type of health care coverage you can purchase. You pay low out-of-pocket expenses for appointments and services, but high monthly premiums. Plans typically feature a small deductible or no deductible and cheap copays or coinsurance.

Why is health policy important in healthcare? ›

Evidence-based health policies can help prevent disease and promote health. For example, smoke-free policies can help prevent smoking initiation and increase quit attempts. Similarly, policies requiring community water systems to provide fluoridated water can improve oral health.

Why is healthcare access important? ›

Why Is Access to Care Important to Health? Together, health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met.

Why is medical coverage important to employees? ›

Comprehensive coverage for the whole family ensures that the employee and their family can receive proper medical care when needed. From preventive services to emergency treatments, health insurance benefits provide stability to loved ones.

Why is health insurance more important than life insurance? ›

Life insurance and health insurance serve different purposes and can meet different needs: Health insurance can protect you financially during your lifetime. Life insurance can provide your loved ones with financial stability after you're gone.

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