If you’re approaching age 65 or already enrolled in a Medicare Insurance Plan in California, you may be wondering if your coverage is enough—or if you should consider adding supplemental insurance.
With rising healthcare costs and evolving coverage options, understanding the gaps in Medicare and the benefits of supplemental plans is crucial for making informed decisions about your health and finances.
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). While these cover a large portion of your healthcare needs, they don’t pay for everything. For example, in 2025, the standard monthly premium for Medicare Part B is $185, with an annual deductible of $257.
After meeting the deductible, Medicare typically pays 80% of approved services, leaving you responsible for the remaining 20%—which can add up quickly, especially for major procedures or ongoing care.
Original Medicare does not cover:
This means that without additional coverage, you could face significant out-of-pocket expenses for coinsurance, copayments, and deductibles.
Supplemental coverage often called Medigap—is designed to help pay for costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Medigap policies are sold by private insurance companies and standardized by the federal government, so you can compare plans easily.
However, Medigap does not cover prescription drugs, so you may need a separate Part D plan for medication coverage.
Alternatively, you might consider a Medicare Advantage Plan (Part C), which combines Parts A and B (and often Part D) into a single plan administered by private insurers. Many Medicare Advantage plans also offer extra benefits like dental, vision, hearing, and wellness programs—benefits not included in Original Medicare.
According to recent statistics, about 41% of Original Medicare beneficiaries nationwide had Medigap coverage in 2022, while the rest faced potential “gaps” in their coverage that could cost thousands per year.
In California, options like Medicare Advantage and Medigap are widely available, with some plans offering premiums as low as $0 per month (not including the standard Part B premium).
As of April 2024, there were approximately 67.3 million Medicare beneficiaries in the U.S., with about half choosing Medicare Advantage plans and half staying with Original Medicare. The popularity of Medicare Advantage has more than doubled over the past decade, reflecting a growing demand for comprehensive, predictable coverage.
Whether you need supplemental coverage depends on your health needs, financial situation, and personal preferences. If you have chronic health conditions, require frequent medical care, or want mental security knowing you’re protected from unexpected costs, supplemental insurance can be a wise investment.
If you’re healthy, rarely visit the doctor, and are comfortable with some financial risk, you might choose to stick with Original Medicare alone. However, keep in mind that health needs can change over time, and enrolling in Medigap is easiest when you first become eligible for Medicare at age 6.
How to Compare Your Options:
For more details on Medicare coverage and supplemental options, visit the official Medicare website: medicare.gov.
Choosing the best Medicare Insurance Plan and supplemental coverage can make a significant difference in both your healthcare and your financial security.
For personalized guidance and to compare plans from top insurers in California, reach out to California Affordable. Our licensed agents are ready to help you navigate your options and answer all your questions.
Call us today at (800) 903-0326 to speak directly with a licensed agent, or contact us today to get started. Protect your health and your wallet with the right coverage tailored to your needs.
Read more: Which Medicare Health Plan Is Best for Seniors?
No, you cannot have both. Medigap policies only work with Original Medicare—not with Medicare Advantage plans.
The best time is during your Medigap Open Enrollment Period, which starts when you’re 65 and enrolled in Medicare Part B. After this window, you may be subject to medical underwriting.
Traditional Medigap plans do not cover prescription drugs. You’ll need to enroll in a separate Medicare Part D plan for prescription coverage.
Some Medigap plans offer limited coverage for emergency care abroad, but Medicare Advantage plans generally do not. Always check your plan details before traveling.
