Medicare Plans in California: Coverage and Costs (2026)

If you're turning 65 in California or helping a parent sort out Medicare, you're facing four parts, dozens of plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D donut hole is gone for good, and California gives you one protection most states don't: a yearly window to switch Medigap plans without a health screening.

This guide walks through every piece of Medicare as it works for Californians in 2026, what it costs, the plan options unique to this state, and how to get help paying for it.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in California (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in California and the Birthday Rule
• Help Paying for Medicare in California
• If You Have Both Medicare and Medi-Cal
• Medicare Enrollment Periods
• Free Medicare Help: California HICAP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or California HICAP at 1-800-434-0222.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government, and it comes in two parts.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.

The hospital deductible went up $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.

Medicare Advantage in California (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.

For 2026, the average Medicare beneficiary nationally can choose from about 32 Medicare Advantage plans with drug coverage. Californians in dense metro areas like Los Angeles, the Bay Area, and San Diego usually see even more.

The Major Insurers in California

California's market is unusual because Kaiser Permanente runs its own integrated network of hospitals and doctors and is one of the largest Medicare Advantage insurers in the state. Other big names include Blue Shield of California, Anthem Blue Cross, Health Net, SCAN Health Plan, UnitedHealthcare, Humana, and Aetna. For 2026, ten new insurers are entering the California market alone, nine of them offering only Dual Eligible Special Needs Plans for people who also have Medi-Cal.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though many plans charge $0 extra.
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors are in-network before you enroll, which matters a lot with Kaiser's closed model.
• Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap.
• Extras vary widely. Compare the dental, vision, hearing, fitness, and transportation benefits, not just the premium.

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If your current plan leaves your area for 2026, you get a Special Enrollment Period to pick a new one, and fewer than 5% of affected Californians are left without an alternative.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with inflation. The base premium is $38.99 a month, though actual plan premiums vary, and increases are capped at 6% a year through 2029. People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in California and the Birthday Rule

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

California offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer has to sell you any plan at the standard rate regardless of your health.

California's Birthday Rule

Here's where California stands apart. Under state law, once you have a Medigap policy you get a 60-day window each year, starting on your birthday, to switch to a different Medigap plan with the same or fewer benefits, with no medical underwriting and no new waiting period. Most states never let you change after your first six months without health questions. California lets you shop your coverage every single year.

A few specifics worth knowing. The new plan has to carry equal or lesser benefits than your current one, so you can move to a cheaper carrier or a leaner plan, not bulk up. Most California Medigap policies are overseen by the California Department of Insurance, except Blue Cross and Blue Shield-branded plans, which fall under the Department of Managed Health Care. If a carrier won't honor the birthday rule, that's who you call.

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. The birthday rule softens the usual risk of picking Medigap, since you're not locked into one carrier for life.

Help Paying for Medicare in California

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

California runs its Medicare Savings Programs through Medi-Cal, the state's Medicaid program. They pay some or all of your Medicare premiums and cost-sharing based on income.

QMB is the most generous, covering your Part B premium and your deductibles and coinsurance, which adds up to meaningful savings over a year. One important 2026 change: after a two-year pause, California reinstated an asset limit for these programs on January 1, 2026. The limit is $130,000 for one person, plus $65,000 for each additional household member, so $195,000 for a couple. The income limits above are tied to the federal poverty level and update each spring, so confirm the current figures with DHCS before you rule yourself in or out.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.

• Resource limits: $16,590 for an individual, $33,100 for a married couple
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help

Apply through Social Security at ssa.gov or call 1-800-772-1213.

If You Have Both Medicare and Medi-Cal

Many people who have Medicare also qualify for Medi-Cal, and California has reshaped how those dual eligibles get care. The state now steers them toward integrated Medi-Medi Plans, which are Exclusively Aligned Enrollment Dual Eligible Special Needs Plans built under CalAIM. A Medi-Medi Plan pairs your Medicare Advantage D-SNP with the matching Medi-Cal managed care plan, so one organization coordinates your doctors, drugs, and long-term services with a single set of member materials.

This replaced the older Cal MediConnect demonstration, which ran from 2014 through the end of 2022. Medi-Medi Plans were available in 12 counties in 2024 and 2025 and expand to more counties in 2026, the year California's statewide matching plan policy takes hold: your Medicare choice leads, and your Medi-Cal plan follows it. If your needs are more intensive, the PACE program is another fully integrated option in many California counties. For the full picture, see our guide to Medi-Medi Plans in California.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. The key dates:

Changes you make during Annual Open Enrollment take effect the following January 1. That's when most people review their plan and switch.

Free Medicare Help: California HICAP

You don't have to figure this out by yourself, and you don't have to pay a broker to help. California's Health Insurance Counseling and Advocacy Program, or HICAP, gives free, unbiased Medicare counseling. It's overseen by the California Department of Aging and delivered locally through Area Agencies on Aging.

A HICAP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• Work out how Medicare fits with Medi-Cal if you have both

Call 1-800-434-0222 and you'll be routed to your county's HICAP office.

Learn More

• Medi-Medi Plans in California
• California Medi-Cal: Programs and Coverage
• California Medi-Cal Asset Limits
• In-Home Supportive Services (IHSS) in California
• Caregiver Support in California

Find personalized help comparing your Medicare options in California at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.