Medicare Supplement

Is Medigap Worth It in Santa Rosa? Start Here

Medigap — also called Medicare Supplement Insurance — is a private policy that helps pay some of the out-of-pocket costs Original Medicare leaves behind, like coinsurance and copays. It is sold by private insurers, but the benefits inside each lettered plan are set by federal rules.

Medicare SupplementSanta Rosa, CA

What Medigap is, and what it is not

Medigap is not Medicare Advantage. You choose one road or the other. If you keep Original Medicare, a Medigap policy can ride along with it. If you enroll in a Medicare Advantage plan, Medigap cannot be used with it, and it is generally illegal for a carrier to sell you one in that situation.

Medigap also does not include prescription drug coverage for people new to Medicare. If you want help with drug costs, you'd add a separate Part D plan.

Which plan letters you can buy in California today

California uses the federal standardized Medigap letters. If you are newly eligible for Medicare now, the plans available to you are:

• Plan A
• Plan B
• Plan D
• Plan G
• Plan G High-Deductible (G-HD)
• Plan K
• Plan L
• Plan M
• Plan N

Plans C and F remain available only to people who were eligible for Medicare before January 1, 2020. If that's you, you can still buy or keep one.

Each letter is a fixed package of benefits. A Plan G from one company covers the same Medicare-approved services as a Plan G from another. What differs is the monthly price, how the insurer handles applications and how the company treats customers over time.

How Medigap pairs with Original Medicare and Part D

Here is the typical setup for someone in Santa Rosa who chooses this path:

1. Enroll in Medicare Part A and Part B (Original Medicare). 2. Buy a Medigap policy from a private insurer licensed in California. 3. If you want drug coverage, enroll in a stand-alone Part D plan.

Original Medicare pays first. Your Medigap policy pays its share of what's left. Your Part D plan handles most prescription drugs at the pharmacy separately.

A few 2026 Part D numbers worth knowing: the annual out-of-pocket cap on covered drugs is $2,100, the maximum Part D deductible is $615, and the old "donut hole" is gone — Part D now has three phases. If drug bills hit hard early in the year, the Medicare Prescription Payment Plan lets you spread those costs across the calendar year at no extra charge.

The California rules that shape your choice

Federal law gives you a six-month Medigap Open Enrollment window that starts the first month you are 65 or older and enrolled in Part B. During that window, insurers must sell you any Medigap plan they offer at their best available rate, regardless of your health.

California adds an important protection on top of that: the "birthday rule." Each year, for a set window around your birthday, Medigap policyholders can switch to another Medigap plan with equal or lesser benefits without going through medical underwriting. The exact length of the window and what counts as "equal or lesser" are spelled out by California law, and the rules have changed over the years, so check the current details with the California Department of Insurance or HICAP (California's SHIP) before you switch.

Outside of open enrollment, guaranteed-issue rights, and the birthday rule, insurers in California can use medical underwriting to decide whether to sell you a policy and at what price.

Who sells Medigap in Sonoma County

Santa Rosa is in Sonoma County, and any Medigap insurer licensed in California can sell to residents here. The table below lists every insurer available in the state and the plan letters each one offers. It includes national names like AARP - UnitedHealthcare Insurance Company, Anthem BlueCross - California, Blue Shield of California Life & Health Insurance Company, Humana, Mutual of Omaha (United World Life Insurance Company) and State Farm Mutual Automobile Insurance Company, along with several other carriers.

Because benefits inside a lettered plan are standardized, comparing insurers is mostly about price and service. It is worth getting quotes from more than one company for the same letter.

How to shop without getting overwhelmed

A few practical steps:

• Decide first whether you want to be on the Original Medicare + Medigap + Part D path, or the Medicare Advantage path. They are different systems.
• If you pick Medigap, choose the plan letter that fits your budget and how you use care.
• Then compare prices for that same letter across insurers.
• Ask each insurer how it has raised rates for existing customers in recent years — California publishes rate information through the Department of Insurance.
• If you already have Medigap, check whether California's birthday rule opens a door to switch this year.

Free, unbiased help is available from HICAP, California's State Health Insurance Assistance Program. HICAP counselors do not sell insurance.