Medicare in Irvine, CA

You should enroll in Medicare during your Initial Enrollment Period (IEP) — the 7-month window that includes the 3 months before, the month of, and the 3 months after your 65th birthday. Missing your IEP without creditable employer coverage triggers permanent late-enrollment penalties: 10% per 12-month period for Part B and 1% per month for Part D. Contact our office 3–4 months before your 65th birthday to start the process.

Medicare Advantage (Part C) is a private plan that replaces Original Medicare and often bundles dental, vision, and hearing — typically $0 additional premium for basic plans. Medicare Supplement (Medigap) works alongside Original Medicare to fill cost-sharing gaps like deductibles and coinsurance, allowing you to see any Medicare-accepting provider nationwide. Advantage plans usually have lower premiums but network restrictions; Medigap plans have higher premiums but virtually unlimited provider access.

Original Medicare (Parts A & B) does not cover routine dental cleanings, fillings, eyeglasses, or routine vision exams. However, many Medicare Advantage plans available to Irvine residents include dental, vision, and hearing benefits at no additional premium. If you prefer Original Medicare plus Medigap, you can purchase standalone dental and vision plans to fill those gaps.

Yes — every year during Annual Enrollment Period (October 15 – December 7), you can switch between Medicare Advantage plans, switch from Advantage back to Original Medicare, or change your Part D prescription drug plan. Medigap plan switches outside of guaranteed-issue periods (like turning 65 or losing employer coverage) require health underwriting in most states, though CA may have additional protections.

Medicare Part A covers inpatient hospital care, skilled nursing facility stays (following a hospital stay of 3+ days), hospice care, and limited home health care. Most people do not pay a premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. In 2024, the Part A deductible is $1,632 per benefit period, not per year — so multiple hospitalizations in a year can trigger multiple deductibles.

Medicare Part B covers outpatient services — doctor visits, preventive screenings, lab tests, durable medical equipment, and outpatient surgery. The standard 2024 Part B premium is $174.70/month, though higher earners pay more via IRMAA surcharges. Part B has a $240 annual deductible, after which Medicare pays 80% and you pay 20% — with no out-of-pocket maximum unless you have a Medigap plan.

Medicare Part D is standalone prescription drug coverage sold by private insurers. You need it if you take any prescription medications; skipping Part D when first eligible results in a permanent late-enrollment penalty of 1% of the national base premium per month you were without creditable drug coverage. Even if you take no medications now, enrolling in a low-cost $0 premium Part D plan protects you from future penalties.

Enroll in Medicare Part B and Part D when first eligible — at 65 — or within your Special Enrollment Period if you have creditable employer coverage. If you or your spouse is still working and covered by a group health plan with 20+ employees, you can delay Medicare without penalty. Always get written confirmation from your HR department that your coverage is 'creditable' before delaying. Our brokers can review your situation to confirm you're protected.

Medicare Supplement Plan G is currently the most comprehensive Medigap plan available to new Medicare enrollees (Plan F is no longer sold to those newly eligible after January 1, 2020). Plan G covers all Medicare cost-sharing except the Part B deductible ($240/year in 2024), making your out-of-pocket exposure highly predictable. It is widely considered the best value for seniors who want near-unlimited provider access and minimal surprise bills.

Yes — this is called 'coordination of benefits,' and the rules depend on employer size. If your employer has 20+ employees, the employer plan pays first (primary) and Medicare pays second (secondary). If the employer has fewer than 20 employees, Medicare pays first. Many people in this situation drop employer coverage to save on premiums, but the right answer depends on your specific plan costs and covered providers.