Medicare 101

The options for Medicare plans and program offerings can be overwhelming.
We're here to help!

Getting Ready for Medicare

If you are turning 65 or retiring, it’s important to start thinking about Medicare. You want the right type of Medicare insurance plan to cover your most important and probable healthcare needs.


Medicare is a federally administered insurance program for people 65 and older that helps pay for health care expenses with a unique benefit structure. Medicare is also available to people under 65 with certain disabilities.


You can sign up for Medicare benefits as early as 3 months prior to your 65th birthday.

Medicare is a “fee-for-service” system, where a Medicare beneficiary is charged a fee for each health care service received. Basic Medicare helps with the cost of health care, but it does not cover all medical expenses, nor the cost of most long-term care. To cover more of their health care costs, many individuals pay for additional Medicare policies to supplement what Medicare pays.


Medicare benefits can change yearly, and the options are complex.

Types of Medicare Coverage

Medicare is the federal health insurance program for:


  • People who are 65+
  • Certain people with disabilities
  • People with End-Stage Renal Disease (ESRD)


A stethoscope is laying on a piece of paper next to a pen

Medicare Part A (Hospital)

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services.

Medicare Part B (Medical)

Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage)

Also called Medicare Part C, these plans combine the benefits of Original Medicare (Part A and Part B) into a single plan with additional coverage, like dental, vision, hearing, wellness, and more. 

Medicare Supplement

Medicare Supplement, or Medigap, bridges the coverage gap left by Original Medicare (Part A and Part B) and covers costs like deductibles, copayments, and coinsurance. 

Medicare Part D (Drug Coverage)

Medicare Part D Prescription Drug Plans (PDP) work in tandem with Original Medicare (Part A and Part B) and Medicare Advantage plans to provide prescription drug coverage. 

Medicare Dental & Vision Plans

Dental and vision plans are additional supplemental products beneficiaries can purchase (as standalone or part of Medicare Advantage) since they are not included in Original Medicare (Part A and Part B) coverage.

Original Medicare

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital) and Part B (Medical). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).


Medicare Plans & Programs

  • Medicare Cost Plan

    A type of Medicare health plan available in some service areas. If a member receives services outside of the plan's provider network without prior authorization or a referral, their Medicare-covered services will be reimbursed according to the Original Medicare fee schedule. The Cost Plan will cover emergency services or urgent care needs.

  • Medicare Health Maintenance Organization (HMO) Plan

    With most HMO-based Medicare Advantage plans, enrollees generally receive covered healthcare services from medical providers who are members of the plan's network, except in emergency situations. Additionally, many HMO plans require an enrollee to obtain a referral from their designated primary care physician prior to receiving specialty or hospital-based care. These types of HMO-based Medicare Advantage plans are offered in select areas.

  • Medicare Medical Savings Account (MSA) Plan

    Medicare Savings Account (MSA) plans pair a high-deductible Medicare Advantage insurance plan with a dedicated financial account. Medicare deposits funds into this account to help cover medical costs. Enrollees can access this money to pay for healthcare expenses, though only costs pertaining to Medicare-covered services will accumulate toward satisfying the plan deductible.

  • Medicare Preferred Provider Organization (PPO) Plan

    Some areas of the United States offer a Medicare Advantage plan where members pay lower costs when utilizing healthcare services from physicians, facilities, and providers within the plan's covered network. While out-of-network care is also available, members would be subject to additional expenses when receiving care outside of the preferred network.

  • Medicare Private Fee-For-Service (PFFS) Plan

    A Private Fee-For-Service plan is a type of Medicare Advantage plan where the plan determines reimbursement levels for healthcare providers and the patient cost-sharing amounts for received medical services. This plan model differs significantly from Original Medicare, and enrollees must carefully adhere to the specific rules of their Private Fee-For-Service plan. Within this plan structure, an individual's out-of-pocket expenses for Medicare-covered benefits may be more or less than under Original Medicare. Close attention to plan benefit designs and network status is important for Private Fee-For-Service enrollees.

  • Medicare Savings Program

    State-administered programs that provide financial assistance to individuals with limited means, enabling them to offset some or all Medicare premiums, deductibles, and coinsurance.

  • Medicare Select

    A type of Medigap policy that may require the policyholder to utilize in-network hospitals and, if applicable, in-network physicians in order to qualify for full insurance benefits.

  • Medicare Special Needs Plan (SNP)

    A Medicare Advantage plan that provides targeted and specialized healthcare to specific patient populations, such as individuals who are dually eligible for both Medicare and Medicaid benefits, reside in nursing homes, or live with particular chronic medical conditions.

  • Program of All-inclusive Care for the Elderly (PACE)

    The Program of All-Inclusive Care for the Elderly (PACE) is a special health plan that provides comprehensive medical and social services covered by both Medicare and Medicaid. In addition to these standard benefits, PACE also offers further medically necessary care and services as determined by an interdisciplinary healthcare team based on the individual's specific needs. By combining medical, prescription drug, social support, and long-term care services, PACE aims to serve enrollees who remain in the community.

  • State Health Insurance Assistance Program (SHIP)

    A state program that receives federal funding to provide free local health insurance counseling services to Medicare beneficiaries.

  • State Pharmaceutical Assistance Program (SPAP)

    A state program that provides financial assistance for prescription drug coverage eligibility based on financial need, age, or medical condition.

The Medicare Health Insurance Counseling and Advocacy Program (HICAP) is a senior advocacy program in California. HICAP is part of the California Department of Aging. 


What does HICAP offer? 


  • Free, unbiased, and objective Medicare information
  • One-on-one counseling by appointment
  • Educational seminars
  • Technical assistance



Other programs for seniors in California


  • Senior Grant Program: Helps low-income seniors (62 years or older) make repairs to their homes 
  • Friendship Line California: A free crisis intervention hotline and warmline for non-emergency emotional support calls 
  • Aging and Disability Resource Connection: A program offered by the California Department of Aging 
  • Alzheimer's/Dementia Support: A program offered by the California Department of Aging 
  • CalFresh Healthy Living: A program offered by the California Department of Aging that focuses on nutrition and physical activity 



Other organizations that support aging adults include: AARP, Alliance for Retired Americans, American Geriatrics Society (AGS), and American Society on Aging.