The Centers for Medicare & Medicaid Services (CMS) has a five-star quality rating system. MoneyGeek used it to determine the most widely available plans in California. Our comprehensive guide shows the best option for several categories. These include plan type, whether or not drug coverage is required and limits for out-of-pocket costs.
However, these are general recommendations. The only way to find one that best fits your needs is to shop around. This way, you can ensure hospitals and providers are in the network of the plan you end up purchasing.
If you're not looking for a Medicare Advantage plan but want to cover out-of-pocket costs that your base Medicare plan doesn't cover, MoneyGeek also ranked the best Medicare Supplement Plans in California.
Best Medicare Advantage Plans in California
Best Medicare Advantage Plan in California - Overall
The ideal way to find the best Medicare Advantage Plan in California for you is to base it on your needs and preferences. For example, MoneyGeek found that the Aetna Medicare Choice Plan from Aetna Medicare is the best health plan for a buyer who wants a PPO plan that includes drug coverage, seven core benefits and a high star rating from the CMS.
A Preferred Provider Organization (PPO) offers several benefits. It gives you a broader network, which means you’ll have more choices of doctors, hospitals or treatment centers. You also won’t need a referral to see a specialist. It provides greater flexibility but typically comes with a higher premium.
MoneyGeek’s analysis shows Aetna Medicare’s Aetna Medicare Choice Plan may be the best for buyers in California who prefer a PPO. Here are its details:
- Monthly premium of $90
- Includes drug coverage
- An in-network max out-of-pocket limit of $6,700
- An overall star rating of 4.5 out of five from CMS
You’ll get the six most common benefits with the Aetna Medicare Choice Plan, including vision, dental, hearing, fitness, worldwide emergency and telehealth. The worldwide emergency coverage makes it a good choice for travelers. It also received a high rating from the CMS and offers Part D drug coverage.
Remember that it may not necessarily be the best option for you. Make sure you consider your needs to help you decide which plan to purchase.
Best HMO Medicare Advantage Plan in California
Your healthcare needs will determine the best HMO Medicare Advantage Plan in California for you. For instance, for a buyer in California looking for an HMO plan that includes drug coverage, seven core benefits and a high star rating from CMS, MoneyGeek found that the Wellcare No Premium by Wellcare is the best option.
HMOs are the most common type of healthcare plan and are likely to be more affordable than PPOs, EPOs and POS. However, you must stay within your network to ensure coverage. The only exception is during an emergency. You’ll also need a referral to see a specialist.
Your unique needs will determine which healthcare plan is best for you. However, for buyers looking for an HMO in California, Wellcare’s Wellcare No Premium plan is their best option. You can expect the following if you purchase it:
- No monthly premium
- Drug coverage
- An in-network max out-of-pocket limit of $2,500
- Scored a perfect five overall star rating from CMS
The Wellcare No Premium plan offers Part D drug coverage and includes all six most common additional benefits. These include worldwide emergency, vision, telehealth, hearing, fitness and dental. It also has a high rating from CMS.
Best Medicare Advantage Plan in California Without Drug Coverage
You’ll have more healthcare plan options if you don’t need Part D prescription drug coverage.
According to MoneyGeek’s research, buyers looking for the best Medicare Advantage Plan in California without drug coverage, seven core benefits and a high star rating from CMS may find Wellcare’s Wellcare No Premium plan to best meet their needs and preferences.
MoneyGeek’s study determined that Wellcare’s Wellcare No Premium plan is the option for buyers in California, regardless of whether they want drug coverage or not.
Besides this, you can expect the following:
- No monthly premium
- A $2,500 in-network max out-of-pocket limit
- A five out of five overall star rating from CMS
Besides its high rating from CMS, Wellcare’s Wellcare No Premium plan includes all six most common additional benefits, including vision, dental, telehealth, worldwide emergency, fitness and hearing.
Best Medicare Advantage Plan in California for Low Max Out-of-Pocket Costs
Although many Medicare Advantage Plans have low or no premium, this may result in more expenses from paying out of pocket. If you want to avoid this, it’s best to find a plan with a low in-network max out-of-pocket limit.
MoneyGeek’s analysis found AVA by Alignment Health Plan is the best option for California buyers looking for a Medicare Advantage plan with a low max out-of-pocket limit, drug coverage, seven core benefits and a high star rating from the Centers of Medicare and Medicaid Services (CMS).
Alignment Health Plan
Excluding health plans with high max out-of-pocket limits, Alignment Health Plan’s AVA is the best possible plan for buyers in California, regardless of whether they prefer to have drug coverage or not. If you opt to go with this plan, here’s what you can expect:
- A monthly premium of $22
- An in-network max out-of-pocket limit of $3,900
A plan with a low max out-of-pocket saves you from astronomical expenses if you have significant medical needs in a year. With AVA, your insurance provider starts shouldering in-network coverages once you’ve reached your max out-of-pocket limit of $3,900. Since it’s a PPO plan, the max out-of-pocket limit for out-of-network coverage is different. For this plan, it’s $9,500.
Medicare Advantage Plan in California - Statistics
Buyers in California can find Medicare Advantage Plans from 24 healthcare organizations. The segment below offers statistics about some plan components. These include plan types, $0 premium plans and commonly-offered benefits.
Knowing these numbers can help you understand which components are widely available versus rare ones.
California Medicare Advantage Plans are a mix of HMO and PPO, with 98.2% offering drug coverage
In California, most Medicare Advantage Plans are Health Maintenance Organizations (HMO) plans. You can find Preferred Provider Organization (PPO) plans, but these only make up around 8.2% of what’s available in the market. 98.2% of these plans offer drug coverage. If you’re looking for one without drug coverage, your options narrow down to HMO plans only.
61% of Medicare Advantage Plans in California have a $0 premium
You can find 100 unique plans with a $0 premium in California. That’s 61% of all Medicare Advantage Plans available in the market. In comparison, the remaining 39% requires you to pay a monthly premium, which costs an average of $47.70.
Telehealth, hearing and vision benefits are common in California, with most plans offering them
Of the various benefits Medicare Advantage Plans offer, the three most common are telehealth, hearing and vision. All plans include the first two. Vision benefit follows closely, which 99% of Medicare Advantage Plans offer. In comparison, home safety devices & modifications, in-home support and emergency response devices are the rarest benefits.
Expert Advice: Finding the Best Medicare Advantage Plan in California
- What types of Medicare Advantage Plans are offered in California?
- What is the best way to shop around for Medicare Advantage plans in California?
Associate Provost and Associate Professor Public Health Sciences at California Baptist University
MoneyGeek collected data from the Centers for Medicare & Medicaid Services 2022 MA Landscape Source Files released in October 2021. Plans in California were filtered down to those that offer drug coverage (unless otherwise noted), offer seven of the most common Medicare Advantage coverage benefits and are available to at least 50% of the population of California based on county availability.
About Mark Fitzpatrick