Best Medicare Companies in Sonoma County, California (2024)

Medicare is a federally funded health insurance program that provides coverage for people:

• aged 65 or older
• with certain disabilities
• with end-stage renal disease

Medicare is divided into different parts that cover different types of healthcare services.

Original Medicare includes Part A and Part B coverage:

• Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.
• Part B covers outpatient medical services, such as doctor visits, preventive care, and diagnostic tests.

In addition to Original Medicare, beneficiaries in Sonoma County may also choose to enroll in a:

Medicare Advantage plan (Part C) offered by private insurance companies. Medicare Advantage plans provide all the benefits of Original Medicare, plus additional benefits such as:

• prescription drug coverage
• dental
• vision
• hearing services

Medicare Part D is a standalone prescription drug plan that is available to all beneficiaries who are enrolled in Original Medicare or a Medicare Advantage plan that does not offer prescription drug coverage. Part D covers the cost of prescription medications.

Overall, Medicare in Sonoma County provides coverage for a wide range of healthcare services, including:

hospital care, doctor visits, prescription drugs, preventive care, and some other medical services.

The specific benefits and costs of Medicare plans can vary, so it’s important to compare different options and choose the plan that best meets your healthcare needs and budget.

To enroll in Medicare in Sonoma County, you must meet either of the four eligibility requirements, which includes:

• being a US citizen
• legal resident who has lived in the US for at least five years
• being aged 65 or older
• having certain disabilities.

You can enroll in Medicare during:

• Initial Enrollment Period (IEP)
• Annual Open Enrollment Period (OEP).

IEP: is a seven-month period that begins three months before your 65th birthday, includes your birth month, and extends for three months after your birth month. During this period, you can enroll in Medicare Parts A and B, as well as other Medicare plans.

OEP: is a period that runs from October 15 to December 7 each year. During this period, you can make changes to your Medicare coverage, including enrolling in a Medicare Advantage plan or a prescription drug plan.

To enroll in Medicare, here are the four options you can choose from:

• visit the official Medicare website (www.medicare.gov) and follow the instructions to enroll online.
• You can also visit a local Social Security office in Sonoma County and enroll in person.
• If you need help enrolling or have questions about your Medicare coverage options, you can contact the local State Health Insurance Assistance Program (SHIP)
• Contact the Sonoma County Council on Aging for assistance.

Yes, there are Medicare Advantage plans that offer dental and vision services in Sonoma County. Medicare Advantage plans are offered by private insurance companies, and they provide all the benefits of Original Medicare, plus additional benefits such as dental, vision, and hearing services.

Many Medicare Advantage plans in Sonoma County offer comprehensive dental coverage.  Here are the top six:

• routine cleanings
• exams
• X-rays
• fillings
• dentures
• Some plans also offer coverage for orthodontics and more extensive dental procedures.

Similarly, many Medicare Advantage plans in Sonoma County offer vision coverage. Here are the top five:

• annual eye exams
• prescription eyewear
• discounts on other vision services
• glaucoma screening
• cataract surgery

It’s important to note that not all Medicare Advantage plans offer dental and vision coverage, and the specific benefits and costs can vary depending on the plan. It’s important to carefully review the plan’s details and compare different options before enrolling in a plan. You can use the Medicare Plan Finder tool on the official Medicare website (www.medicare.gov) to search for Medicare Advantage plans that offer dental and vision coverage in Sonoma County.

The Medicare Star Rating System is a quality rating system that measures the performance of Medicare Advantage plans and Medicare Part D prescription drug plans. The star rating system is designed to help beneficiaries compare and choose the best Medicare plans based on quality and performance.

The star ratings are based on three factors, including:

• customer satisfaction surveys
• clinical quality measures
• health plan administrative data

Plans are rated on a scale of one to five stars, with five stars being the highest rating.  The star ratings can impact your choice of plans in Sonoma County in three ways:

• higher-rated plans may offer better quality care, more comprehensive benefits, and better customer service than lower-rated plans.
• Medicare Advantage plans with four or five stars are eligible for bonus payments from Medicare, which can help to offset the cost of the plan and provide additional benefits to beneficiaries.
• Beneficiaries who enroll in a Medicare Advantage plan with a rating of four stars or higher are eligible to switch to a different plan at any time during the year, not just during the annual Open Enrollment Period.

When choosing a Medicare plan in Sonoma County, it’s important to consider the star ratings and other quality metrics, along with these three factors such as:

• plan’s network of healthcare providers
• cost-sharing requirements
• covered benefits

You can use the Medicare Plan Finder tool on the official Medicare website (www.medicare.gov) to compare plans and their star ratings in Sonoma County. You can also contact the local State Health Insurance Assistance Program (SHIP) or the Sonoma County Council on Aging for assistance in selecting the best Medicare plan for your needs.

If you have a Medicare Part D prescription drug plan in Sonoma County, you can find out if a specific prescription drug is covered by your plan by reviewing the plan’s formulary. A formulary is a list of prescription drugs that are covered by the plan and their corresponding copays or coinsurance amounts.

You can usually access your plan’s formulary by visiting the plan’s website or calling the plan’s customer service number. The formulary may be updated periodically, so it’s a good idea to check it regularly to make sure that your medications are still covered.

If you find that your medication is not covered by your current plan, you may be able to switch to a different plan that does cover your medication. The annual Open Enrollment Period (OEP) is the best time to make changes to your Medicare coverage, including switching to a new Part D plan. The OEP typically runs from October 15 to December 7 each year.

In some cases, your healthcare provider may be able to help you find a medication that is covered by your plan or suggest alternatives that are covered. You can also contact the local State Health Insurance Assistance Program (SHIP) or the Sonoma County Council on Aging for assistance in navigating your Medicare coverage and finding a plan that meets your needs.