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 federal law doesn't: a yearly window to switch Medigap plans without a health screening.1,2

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 Plans 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 Help Comparing Medicare Plans in 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, check the cost pages at Medicare.gov or call California HICAP at 1-800-434-0222.5

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.6

The hospital deductible went up $60 from 2025.1 A benefit period starts the day you're admitted and ends once you have gone 60 days in a row without inpatient hospital care or skilled care in a SNF.1 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. Part B doesn't cover routine dental, vision, or hearing.7 Most Medicare Advantage plans offer routine dental, vision, and hearing benefits instead, so check what a specific plan actually covers before you count on it.8

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)1
• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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.9

Medicare Advantage Plans in California (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They must cover every medically necessary service Parts A and B cover except hospice, which Original Medicare keeps paying for even after you join a plan, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.8

For 2026, the average Medicare beneficiary nationally can choose from about 32 Medicare Advantage plans with drug coverage.10

How Much Choice You Have in California

CMS counts 402 Medicare Advantage plans available in the state for 2026, down from 421 in 2025, and 99.89% of Californians with Medicare can get to at least one of them.11 KFF's analysis of the CMS landscape files puts the number of insurers available to the average California beneficiary at 12. KFF counts only individual plans open for general enrollment, leaving out Special Needs Plans and employer plans, so its numbers can't be lined up against CMS's 402.11 That same analysis found every one of the ten firms entering the Medicare Advantage market nationwide for 2026 is selling only in California, nine of them offering only a Dual Eligible Special Needs Plan for people who also have Medi-Cal, and the tenth offering two HMO plans.11

How much of that choice reaches you depends on your ZIP code, so the statewide count is a ceiling, not what you'll see on your own screen. Run your ZIP through the Plan Finder below to get your real list.

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. CMS notes that some plans may have a $0 premium and may help pay all or part of your Part B premium, so check that on the plan's benefit summary.1,8
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors are in-network before you enroll. It matters most under an HMO, which generally requires in-network providers except for emergency care, out-of-area urgent care, and temporary out-of-area dialysis.8
• Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap of its own, and CMS's full sentence is that there is no yearly limit on what you pay out of pocket unless you have supplemental coverage such as Medigap, Medicaid, employer, retiree, or union coverage.8
• Extras aren't universal. Check the dental, vision, and hearing benefits a specific plan actually covers, not just the premium.7

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 plan's contract with Medicare isn't renewed for the coming year, you get a Special Enrollment Period from December 8 through the last day of February to switch.12 And you are very likely to have something to switch to: when plans were terminated at the end of 2025, KFF found that fewer than 5% of the Californians affected had no Medicare Advantage drug plan option in 2026.11

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.2 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; some plans charge none, and certain insulins and vaccines are exempt from it).13
2. Initial coverage: in the standard benefit, you pay 25% coinsurance on covered drugs.2
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you owe no cost sharing for covered Part D drugs the rest of the calendar year.2

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025, and CMS set the 2026 amount in the CY 2026 Rate Announcement.2 The base premium is $38.99 a month, though actual plan premiums vary, and year-over-year increases in that base premium are capped at 6%.1 People who qualify for Extra Help often pay much less, sometimes nothing.14

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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.

California offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N.15 Plans C and F can't be sold to people new to Medicare, meaning you turned 65 on or after January 1, 2020 and also got Part A on or after that date. So if you had Medicare before 65 because of a disability or End-Stage Renal Disease (ESRD) before 2020, the closure doesn't apply to you, and if you were eligible before 2020 but haven't enrolled yet, you may still be able to buy Plan C or Plan F.15,16 Plan G is the closest option for people new to Medicare, with the same benefits as Plan F except the Part B deductible: 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.17,1

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 can't refuse to sell you any Medigap policy it offers or charge you more because of your health. It can still make you wait up to six months for coverage of a pre-existing condition, unless you had at least six months of continuous prior creditable coverage.17

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.3 The federal Medigap Open Enrollment Period is a one-time, six-month window.17 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; policies from Anthem Blue Cross and Blue Shield of California fall under the Department of Managed Health Care instead. The birthday rule applies either way: a parallel provision of state law covers the plans DMHC regulates, so holding an Anthem or Blue Shield policy doesn't cost you the protection.3 If a carrier won't honor it, your regulator is who you call.

Medigap or Medicare Advantage?

While you're in a Medicare Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. That isn't a permanent lock-out: if you join a Medicare Advantage plan for the first time and aren't happy with it, federal law gives you a trial right to buy a Medigap policy if you return to Original Medicare within 12 months of joining.8 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.4

Those are the gross income limits, exactly as DHCS publishes them, before the program applies the $20 of monthly income it disregards. They are not hard cut-offs. DHCS footnotes that same table to say the limits "include amounts that will not be counted when deducted in the eligibility determination," and that "if you have income that is over the amounts listed above, you can still apply because there may be more deductions that may be applied." QMB and SLMB also require that you be entitled to or have Medicare Part A, and QI adds that you cannot also receive Medi-Cal.4 The distinction matters, because you'll find different numbers on federal pages. Social Security's POMS manual, in the row that covers California ("All States except Alaska and Hawaii"), publishes the same QMB limit as $1,350 for an individual and $1,824 for a couple, and the same SLMB and QI individual limits as $1,616 and $1,816. Each of those is the DHCS figure with that $20 disregard already counted in. Neither set is wrong, and the gap between them is the disregard, not an error.4,1

For you, the practical consequence is this: being a few dollars over a number in the table above doesn't necessarily put you out of reach, so apply anyway and let Medi-Cal run the calculation. Social Security tells its own staff the same thing: "Even if the individual's income or resources appear somewhat higher than the state limits, encourage them to apply for the MSPs." That goes double for QDWI, whose federal limits of $5,405 for an individual and $7,299 for a couple sit far above the DHCS figure because, as POMS puts it, they "incorporate earned income disregards, in addition to the $20 general income disregard."4

QMB is the most generous: DHCS lists it as paying your Medicare Part A and Part B premiums, deductibles and copayments, which adds up to meaningful savings over a year. There is also an asset limit. DHCS states that "starting January 1, 2026, the asset limits to determine MSP eligibility are $130,000 for an individual, and $65,000 for each additional household member up to 10," so a couple's limit is $195,000. It describes assets as "things that you own, such as bank accounts, cash, second homes and vehicles," and that "such as" is doing real work: DHCS's MSP page gives examples, not a list of what is excluded, so don't assume any particular asset is or isn't counted.4 The income limits above are the 2026 figures DHCS publishes, so confirm the current ones 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. Under Extra Help your plan deductible is $0, and your premium is covered only up to a limit worth knowing before you choose a plan: Medicare pays the premium subsidy against your service area's regional benchmark premium, so if you pick a plan that costs more than the benchmark, you owe the difference yourself.14

• Income limits: $23,940 a year for an individual, $32,460 for a married couple, which is 150% of the 2026 federal poverty guidelines for a one- and two-person household. The limit is higher if family members you support live with you, and not every dollar counts toward the test, so apply rather than rule yourself out on income alone14
• Resource limits: $18,090 for an individual, $36,100 for a married couple living together. Your home, your car, and your personal possessions don't count. The lower limits of $16,590 and $33,100 apply only if you tell Social Security none of your resources will go toward funeral or burial expenses14
• If you already have QMB, SLMB, or QI, full Medi-Cal, or SSI, you automatically qualify for Extra Help and don't need to apply14

Apply through Social Security at ssa.gov or call 1-800-772-1213.14

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.18 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 2022.18 Medi-Medi Plans were available in 12 counties in 2024 and 2025 and reach 41 counties in 2026, the year California's matching plan policy is being implemented in every county: your Medicare choice leads, and your Medi-Cal plan follows it.18 If you need nursing-home-level care but live in the community, the PACE program is another route to look at.7 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:19

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

Free Help Comparing Medicare Plans in 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, offers free one-on-one Medicare counseling to older adults and their families. The California Department of Aging contracts with partners that coordinate HICAP, whose volunteers provide free one-on-one counseling.5

A HICAP counselor can help you:

• Understand Medicare Parts A and B5
• Compare Medicare Advantage and Part D prescription drug plans, and understand Medigap plans5
• Learn about Medicare Savings Programs and Extra Help with medication costs5
• Sort out enrollment, claims, appeals, and questions about hospital bills5

To reach HICAP, call 1-800-434-0222.5

Learn More

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.