What is Medicare Advantage?

Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. It usually combines Part A, Part B, and often Part D prescription drug coverage.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare is run by the federal government and lets you use any provider that accepts Medicare. Medicare Advantage is offered by private insurers and often uses provider networks.

What is Medicare Supplement or Medigap?

Medicare Supplement, also called Medigap, works with Original Medicare to help reduce out-of-pocket costs. It can help cover certain copays, coinsurance, and deductibles.

Does Medigap include prescription drug coverage?

Medigap plans sold today do not include prescription drug coverage. Most people need a separate Medicare Part D plan for medications.

What is Medicare Part D?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover medication costs based on the plan’s formulary.

When is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period usually runs from October 15 to December 7 each year. During this time, many people can review or change Medicare Advantage and Part D plans.

Can I switch Medicare Advantage plans later?

Yes, but timing matters. Most people can switch during Annual Enrollment, Medicare Advantage Open Enrollment, or a qualifying Special Enrollment Period.

What is the difference between HMO and PPO Medicare Advantage plans?

HMO plans usually require in-network care and may need referrals. PPO plans generally offer more provider flexibility but may cost more for out-of-network care.

Do Medicare Advantage plans require prior authorization?

Many Medicare Advantage plans require prior authorization for certain services. This can include imaging, surgeries, skilled nursing care, or other covered treatments.

Do Medicare Advantage plans have an out-of-pocket limit?

Yes, Medicare Advantage plans include an annual maximum out-of-pocket limit for covered medical services. Original Medicare does not include this protection by itself.

Why do Medicare plans change every year?

Plans may update premiums, copays, drug formularies, provider networks, and benefits each year. Reviewing your plan annually helps avoid unexpected changes.

How can I find a Medicare plan that includes my doctor?

You should check the plan’s provider network before enrolling. A local Medicare agent can help confirm whether your doctors and hospitals are included.

IRMAA is an income-related adjustment that can increase Medicare Part B and Part D premiums. It is based on your reported income from prior tax years.

What is a Special Enrollment Period?

A Special Enrollment Period allows certain Medicare changes outside normal enrollment windows. Qualifying events may include moving, losing coverage, or plan changes.

Why work with a local Medicare agent?

A local Medicare agent can help compare plan options, explain networks, and review coverage based on your area. This can make Medicare decisions easier to understand.

Medicare in Los Angeles County: The Complete 2026 Guide

July 6, 2026

By Paul Barrett, CMIP | The Modern Medicare Agency | Independent, licensed in 37 states Last updated: July 2026

Los Angeles County is one of the largest, most competitive Medicare markets in the entire country — 74 Medicare Advantage plans, some of the best-known hospital systems anywhere, and enough advertising noise to make anyone’s head spin. This page is the starting point for making sense of it all: a plain-English map of your options, honest carrier-by-carrier reviews, and neighborhood-specific guidance, all in one place.

I’m independent — I represent more than 40 carriers, so nothing on this page or anywhere in this guide is written to steer you toward one company. It’s written so you understand the real landscape before you decide anything.

THE CORE CHOICE: MEDICARE ADVANTAGE OR MEDIGAP

Most parts of the country have a handful of Medicare Advantage plans and one or two dominant hospital systems. LA County has 74 different Medicare Advantage plans and multiple major, competing hospital networks — Kaiser, UCLA Health, Providence, Cedars-Sinai, Huntington Health, MemorialCare, and more, depending on which part of the county you’re in.

That competition is genuinely good news in some ways — the average out-of-pocket maximum for Medicare Advantage plans here runs around $2,428, far below the national ceiling of $9,250, and nearly everyone has access to a $0 premium plan. But it also means “which plan is best” has a different answer in Santa Monica than it does in Pasadena or Long Beach, because which hospital system dominates your specific neighborhood changes the calculation.

California also has a genuine advantage baked into state law: the Medigap Birthday Rule. Each year, within 60 days of your birthday, you can switch to another Medigap plan with equal or lesser benefits without medical underwriting — something most states don’t offer. That’s worth knowing whether you’re on Medicare Advantage or Medigap today.

The Foundation: What Medicare Actually Is in 2026

Before comparing plans, it helps to understand what you’re working with. Medicare has four parts that interact differently depending on which coverage path you choose.

Part A — Hospital Insurance Covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care. Most people pay $0/month for Part A if they or their spouse paid Medicare taxes for at least 10 years. The Part A hospital deductible in 2026 is $1,736 per benefit period — not an annual deductible. It can reset if you’re hospitalized multiple times in a year.

Part B — Medical Insurance Covers doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment. The standard Part B premium in 2026 is $202.90/month. After a $283 annual deductible, Medicare pays 80% of approved costs. You’re responsible for the other 20% — with no annual cap under Original Medicare. That uncapped 20% is the single biggest reason people add supplemental coverage.

Part C — Medicare Advantage A private plan alternative to Original Medicare that bundles hospital, medical, and usually drug coverage into one plan. Uses networks of providers. Detailed in the Medicare Advantage section below.

Part D — Prescription Drug Coverage Standalone drug plans from private insurers. Can be added to Original Medicare or bundled inside a Medicare Advantage plan. Detailed in the Part D section below.

The Three Paths in LA County

PART ONE: MEDICARE ADVANTAGE IN LOS ANGELES COUNTY

2026 Fast Facts

For 2026, residents of Los Angeles County can choose from 74 Medicare Advantage plan options. Of these, 65 cost nothing beyond the Part B premium. Enrollment in the county stands at approximately 559,063, with 48% of plans achieving 4 stars or better.

Fact	2026 Figure
Total MA plans available	74
Plans with $0 monthly premium	65 (of 74)
Average HMO premium	$2.42/month
Average PPO premium	$17.25/month
Average out-of-pocket maximum	$2,428
National MOOP ceiling	$9,250
Plans rated 4 stars or higher	48%
HMO plans	52 (covering 463,081 beneficiaries)
PPO plans	8
Total MA enrollment in LA County	~559,063

Source: CMS Medicare Advantage Enrollment Data / Medicare.org, May 2026

The MOOP advantage is real and significant. LA County’s average Medicare Advantage out-of-pocket maximum of $2,428 is dramatically below the national ceiling of $9,250. This reflects the intense carrier competition in this market — carriers compete aggressively on benefits here in a way they simply don’t in smaller markets.

Top Plans by Enrollment

Top 3 Plans by Enrollment as of May 2, 2026:

Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) — 180,321 enrollees
SCAN Classic (HMO) — 83,566 enrollees
AARP Medicare Advantage from UHC CA-004P (HMO-POS) — 40,936 enrollees

Kaiser’s enrollment dominance is striking — 180,321 members in a single plan, more than double the second-largest carrier. This reflects Kaiser’s fully integrated model: their members tend to stay because the system is self-contained and the model works well for people who thrive within it.

Honest Carrier Assessments

SCAN Health Plan A Long Beach-based, not-for-profit carrier with nearly 50 years of local history and a 13-year streak of 4-star-or-higher CMS ratings. SCAN keeps most HMO plans at $0 monthly premiums in 2026, with the Classic Prime HMO offering a MOOP of $2,400–$2,499 in-network. Their Venture plans offer Part B givebacks up to $185/month. SCAN is the right fit for people who want a proven, community-rooted HMO with a genuine Long Beach/LA County identity and solid everyday benefits. For a deep-dive see our full 2026 SCAN Health Plan review.

Kaiser Permanente A fully integrated system — your doctors, hospital, and pharmacy all live under one roof.Kaiser Permanente is rated 4.5 CMS stars and operates as an integrated HMO system in Los Angeles. The flagship Senior Advantage plan has a remarkably low out-of-pocket maximum and the integrated model produces genuinely excellent care coordination for people who want everything in one place. The caveat: Kaiser is a closed system. Your Kaiser doctor refers you to a Kaiser specialist at a Kaiser facility. If you already have established relationships with non-Kaiser physicians — at UCLA Health, Cedars-Sinai, or Providence — those relationships end when you enroll in Kaiser. Also worth noting: Kaiser reached a $556 million False Claims Act settlement with the DOJ in January 2026 over allegations that Kaiser pressured physicians to add diagnoses to patient records after visits in order to increase Medicare Advantage reimbursements. Kaiser did not admit wrongdoing and stated it settled to avoid prolonged litigation. The settlement has no bearing on quality of care today, but it’s context worth having before you enroll. See how Kaiser compares in SCAN vs. Alignment vs. Kaiser: Which Plan Fits Your LA Neighborhood?

Alignment Health Plan A newer, tech-forward carrier with strong CMS quality ratings but a documented gap in member experience and complaint rates compared to SCAN and Kaiser. Worth considering if you’re generally healthy and want a lower-cost, digital-first experience — worth a closer look before enrolling if you have ongoing complex health needs. Read our full Alignment Health Plan review for both sides.

UnitedHealthcare (AARP branded)UnitedHealthcare AARP Medicare Advantage is the third most enrolled plan in LA County with 40,936 enrollees in their HMO-POS plan. UHC’s breadth of network is a genuine advantage — their HMO-POS structure allows some out-of-network flexibility that standard HMOs don’t. For people who want a nationally recognized carrier with a large provider directory, UHC is worth comparing.

UCLA Health Medicare Advantage A newer plan built around direct access to UCLA Health’s academic medical system. Genuinely compelling if you already see UCLA doctors and want to stay within that system. The trade-off: UCLA Health Medicare Advantage doesn’t yet have a CMS star rating, and its network is narrower than the county-wide carriers. For a full assessment see our UCLA Health Medicare Advantage review.

Anthem Blue Cross Anthem offers plans across LA County with a generally broad provider network. Blue Shield of California carries 4.0 stars and has an expanding D-SNP presence in the county. For dual-eligible residents, the Anthem Full Dual Advantage Aligned D-SNP is the most enrolled Special Needs Plan in LA County with 51,848 enrollees — significant scale for a plan targeting this population.

HMO vs. PPO: What It Means in LA County

HMO: Requires in-network providers only, requires primary care physician referrals for specialists, typically the lowest premiums. In 2026, LA County has 52 HMO plans covering 463,081 beneficiaries with an average premium of $2.42/month.HMOs work exceptionally well in LA County because the competing hospital systems — Kaiser, UCLA, Cedars-Sinai, Providence, MemorialCare, Huntington Health — each have deep, mature provider networks. If your care is consolidated within one system, an HMO often provides the best value.

PPO: See any Medicare-accepting provider in or out of network, no referrals.PPO plans in LA County average $17.25/month. The PPO structure is particularly valuable in LA County for people whose specialists are at different systems — one at UCLA, one at Cedars-Sinai — or who travel extensively and need coverage that works outside Southern California.

HMO-POS: A hybrid — HMO pricing with limited ability to go out-of-network for select services. The most popular plan in this category is AARP/UHC’s HMO-POS with 40,936 enrollees.

Your Neighborhood Matters — City-Specific Guides

LA County spans 4,058 square miles and multiple distinct hospital markets. The right plan in Santa Monica is genuinely different from the right plan in Pasadena or Long Beach because the dominant hospital systems differ significantly by neighborhood.

Santa Monica — Medicare in Santa Monica: Your Honest 2026 Local Guide
Pasadena — Medicare in Pasadena: What Huntington Health’s Network Means for Your 2026 Plan
Long Beach — Best Medicare Plans in Long Beach: The Honest 2026 Guide
Santa Monica vs. Pasadena — Why Your ZIP Code Matters in Los Angeles County

The Part B Giveback — The Honest Version

You’ve seen the commercials: “Get money back in your Social Security check.” The Part B Giveback — or Part B Premium Reduction — is real. Some Medicare Advantage plans reduce your $202.90 monthly Part B premium by paying a portion of it back to you.

SCAN’s Venture plans offer Part B givebacks up to $185/month for eligible LA County members.

But here’s what the commercials leave out: the biggest giveback isn’t always the best overall deal. A plan offering $100/month back that has a $5,000 out-of-pocket maximum may serve you far better than a plan offering $185/month back with a $7,500 MOOP and a narrower network. Always look at the total value picture — giveback + MOOP + network + drug formulary — before choosing based on the giveback number alone.

For a verified plan-by-plan breakdown: The Part B Giveback Explained: What LA Retirees Need to Know

You’ve probably seen commercials promising “money back in your Social Security check.” That’s real, but the honest version is more nuanced than the ads suggest — most givebacks are much smaller than the flashy numbers advertised, and the biggest giveback isn’t always the best overall deal. Full guide, with a verified plan-by-plan breakdown: The Part B Giveback Explained: What LA Retirees Need to Know https://www.paulbinsurance.com/part-b-giveback-los-angeles/

PART TWO: MEDIGAP (MEDICARE SUPPLEMENT) IN LOS ANGELES COUNTY

What Medigap Is and Why It Matters in LA

Medigap is private insurance that fills the gaps Original Medicare leaves behind. Remember that uncapped 20% Part B coinsurance we mentioned? With a good Medigap plan, that goes away. The Part A hospital deductible that can hit multiple times in a year? Covered. Skilled nursing facility costs for days 21-100 at $217/day? Covered.

With Medigap, you keep Original Medicare. Any doctor or hospital in the country that accepts Medicare accepts your coverage — no network calls, no prior authorizations, no worrying whether this year’s carrier still has a contract with your hospital. In a county with as many competing hospital systems as LA County, that freedom has real value.

The trade-off is real: Medigap costs more each month than a $0 Medicare Advantage plan, and it doesn’t include dental, vision, or prescription drugs. But for people managing complex conditions, seeing specialists across multiple systems, or simply wanting to know exactly what their healthcare will cost — Medigap deserves serious consideration.

California’s Medigap Rules: What Makes This State Different

California offers two consumer protections that most states don’t:

1. The Standard Medigap Open Enrollment Period This is a federal rule that applies everywhere: when you first enroll in Medicare Part B at age 65, you have a 6-month open enrollment period during which any Medigap carrier must accept you at standard rates, regardless of health. This is your strongest window. Use it.

2. California’s Birthday Rule — A Genuine State Advantage -California’s Birthday Rule gives Medigap policyholders the freedom to shop for better rates every year. Starting on your birthday, you have a guaranteed-issue window to switch to any Medigap plan of equal or lesser value from any insurer, with no health questions and no medical underwriting — something beneficiaries in most other states simply cannot do.

In practical terms: if you’re on Plan G and your carrier raises rates, you can switch to another carrier’s Plan G at renewal time — every year — without answering health questions. You cannot use the Birthday Rule to upgrade to a plan with richer benefits (Plan N to Plan G, for example), but you can switch laterally or downgrade.

Real-world example: one client saved about $80/month (nearly $1,000 annually) by switching from Blue Shield Medigap Plan G to an AARP/UnitedHealthcare Plan G using the Birthday Rule.

This is one of the most powerful consumer protections in any state’s Medicare rules. Mark your birthday on the calendar as your annual Medigap shopping day.

For the complete guide to using this rule: California Birthday Rule 2026: Your Annual Gift for Better Medigap Savings

The Plans: What Each One Covers

Medigap benefits are standardized by federal law. A Plan G from State Farm covers exactly the same things as a Plan G from UnitedHealthcare or Anthem. The only differences between carriers for the same plan letter are price, customer service quality, and long-term rate stability.

Plan G — The Most Comprehensive Option for New Enrollees

Plan G covers virtually everything Original Medicare doesn’t pay, with one exception: the annual Part B deductible ($283 in 2026). After you pay that once per year, your out-of-pocket on covered services is essentially zero. Covers:

100% of Part A hospital deductible ($1,736 per benefit period)
100% of hospital coinsurance for days 61-90 and lifetime reserve days
100% of skilled nursing facility coinsurance ($217/day for days 21-100)
100% of Part B coinsurance (the 20%)
100% of Part B excess charges
80% of emergency care outside the US (up to $50,000 lifetime)

Does NOT cover: prescription drugs (need Part D), dental, vision, or hearing.

Plans C and F — which covered the Part B deductible — are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the closest available alternative for newer enrollees.

Plan N — Lower Premium, Small Copays

Plan N covers the same major hospital and skilled nursing costs as Plan G, but with two differences: you pay up to $20 for office visits and up to $50 for ER visits that don’t result in an inpatient admission. In exchange, Plan N premiums run roughly $30-50/month less than Plan G in California.

Plan N does not cover Part B excess charges — meaning if your doctor charges more than Medicare approves, you could owe the difference. However, in California this risk is lower than in many states because California law limits balance billing practices.

High Deductible Plan G — For the Cost-Conscious Healthy Enrollee

High Deductible Plan G provides the same ultimate coverage as standard Plan G but requires you to pay all Medicare-covered costs until you reach a $2,950 annual deductible (2026). After that, everything standard Plan G covers kicks in fully. Monthly premiums are dramatically lower than standard Plan G. For a generally healthy person who wants Medigap’s structural provider freedom without the full monthly premium, this is the most underutilized option in the market.

What Medigap Plans Cost in California — 2026 Rates

California uses both attained-age and issue-age pricing depending on the carrier — unlike New York’s community rating where everyone pays the same regardless of age. In California, your age at enrollment matters, and premiums increase as you get older with attained-age pricing.

State Farm has California’s cheapest Plan G at $166/month and Plan N at $127/month for a 65-year-old. Rate differences for identical coverage reach $74/month in California.

2026 California Plan G Monthly Premium Range (age 65, non-smoker)

Carrier	Approximate Plan G Monthly Premium
State Farm	~$166
Bankers Life	~$170s
Mutual of Omaha	~$180s
UnitedHealthcare (AARP)	~$190-$220
Anthem Blue Cross	~$200-$240
Blue Shield of California	~$200s

Source: MoneyGeek California Medigap rate data, May 2026. Rates vary by ZIP code, age, gender, and tobacco status. Los Angeles County rates may differ from statewide averages.

<cite index=”39-1″>The $35/month gap between the cheapest and most expensive Plan N carriers in California represents $420/year for identical benefits — a 27% price premium for the same coverage.

What this means for LA County residents: Because benefits are standardized, there is never a coverage reason to choose the more expensive carrier for the same plan letter. The only reasons to pay more are rate stability history, customer service reputation, or household discounts (some carriers discount 5-10% when both spouses enroll). An independent broker can pull side-by-side quotes from multiple carriers for your specific LA County ZIP code.

The Medigap + Part D Annual Cost in LA County

Medigap doesn’t include drug coverage. A typical LA County resident on Plan G needs to add a Part D plan:

Cost Component	Estimated Annual Amount
Plan G premium (approx. $180-220/month)	~$2,160–$2,640/year
Part B premium ($202.90/month)	$2,434.80/year
Part B deductible	$283/year
Part D plan (see Part D section below)	$20–$100+/month
Total annual commitment	~$5,000–$6,000+
Out-of-pocket on covered medical services	$0 after Part B deductible

This is significantly more per month than a $0 Medicare Advantage plan. But for people with complex health needs, multiple specialists, or simply a desire to see any Medicare provider in the country without restriction, the predictability and freedom of Medigap has real financial value when something serious happens.

PART THREE: MEDICARE PART D IN LOS ANGELES COUNTY

What Part D Is and Why It Matters

Medicare Part D provides prescription drug coverage through private insurance plans approved by Medicare. It can be:

A standalone PDP (Prescription Drug Plan) added to Original Medicare + Medigap
Bundled inside a Medicare Advantage plan (MAPD)

If you’re on Medigap (Path 1), you need to add a standalone Part D plan separately. If you’re on Medicare Advantage, drug coverage is almost always included — only 3 of 74 LA County MA plans exclude Part D.

2026 Part D Facts for Los Angeles County

Medicare Part D premiums in Los Angeles range from $1.80 to $183.50/month for 2026. The California benchmark for Part D — the threshold at which Extra Help/Low Income Subsidy covers the full premium — is at or below $12/month in 2026.

The average standalone Part D plan total premium nationally is projected to decrease from $38.31 in 2025 to $34.50 in 2026.

Key 2026 Part D numbers:

Feature	2026 Amount
Annual out-of-pocket cap on covered drugs	$2,100
Maximum Part D deductible	$590
National average standalone PDP premium	~$34.50/month
LA County Part D premium range	$1.80–$183.50/month
California Extra Help/LIS benchmark	At or below $12/month

The $2,100 out-of-pocket cap is new and significant. Starting in 2024 and continuing in 2026, Medicare Part D has a hard annual cap on what you pay out of pocket for covered drugs. Once you hit $2,100, your drugs are covered at 100% for the rest of the year. This dramatically changed the value calculation for people on expensive specialty medications.

How to Choose a Part D Plan in LA County

Part D plans vary significantly — and not just by premium. Here’s what actually matters:

1. Your formulary — the most important thing Each plan has its own list of covered drugs (formulary) organized into tiers. A drug on Tier 1 costs you almost nothing. The same drug on Tier 3 or Tier 4 can cost hundreds. Before enrolling in any Part D plan, run your specific medications through Medicare’s Plan Finder at medicare.gov/plan-compare to see your actual estimated annual drug costs under each plan.

2. Your pharmacy Most Part D plans have preferred pharmacy networks. Using a preferred pharmacy can reduce your copays significantly. CVS, Walgreens, Rite Aid, and major grocery pharmacy chains have preferred status in many plans — but verify for each plan before you enroll.

3. Premium vs. total cost The lowest-premium Part D plan is almost never the lowest total cost for someone taking multiple medications. A plan with a $15/month premium but high drug tiers for your specific medications can cost far more annually than a plan with a $45/month premium and better formulary placement for your drugs.

4. Annual review is essential Part D plans change formularies every year. A drug that was Tier 2 in 2025 may be Tier 4 in 2026. Every October during Annual Enrollment Period, review your Part D plan against your current medications. This is not optional — it’s the difference between paying $40/month and $200/month for the same prescriptions.

Extra Help — A Program Many LA County Residents Qualify For

Extra Help (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay Part D costs — premiums, deductibles, and copays.

In California, the benchmark premium for qualifying plans is at or below $12/month in 2026. If you receive Extra Help, you pay no premium for a benchmark plan, no deductible, and small copays of $5.10 for generics and $12.65 for brand-name drugs.

Many people who qualify for Extra Help don’t know they qualify. If your income is below roughly $22,590/year (individual) or $30,660/year (couple) in 2026, you may be eligible. Call 1-800-MEDICARE or contact your local HICAP (Health Insurance Counseling and Advocacy Program) office to find out.

PART FOUR: THE BIG DECISION — MEDICARE ADVANTAGE OR MEDIGAP?

This is the fork in the road that matters most for LA County residents. Here’s the honest side-by-side:

Factor	Medicare Advantage	Medigap + Part D
Monthly premium	Often $0	$200-$350+/month (Medigap + Part D)
When you USE care	Copays and coinsurance up to MOOP	Minimal after Part B deductible
Average worst-case annual cost	~$2,428 MOOP (LA County avg.)	~$283 Part B deductible + any Part D costs
Provider network	Must use plan’s network	Any Medicare-accepting provider nationwide
Dental/vision/hearing	Often included	Not included — buy separately
Works in all 50 states	Generally limited to home network	Yes — Medigap + Original Medicare works everywhere
Plan changes year to year	Plans change annually — review required	More stable, but premiums rise over time
Good for travelers/snowbirds	Less ideal	Ideal
Birthday Rule advantage	Doesn’t apply	Applies — shop rates annually without underwriting

The honest recommendation:

For a generally healthy 65-year-old in LA County who wants to minimize monthly premiums, has established relationships with providers within one hospital system, and doesn’t travel extensively — Medicare Advantage often makes financial sense. LA County’s average MOOP of $2,428 is extraordinarily competitive, and the extra benefits (dental, vision) add real value.

For someone managing a serious or chronic health condition, seeing specialists across multiple systems, traveling or splitting time between states, or simply wanting the certainty of knowing what they’ll pay regardless of what happens medically — Medigap provides structural protection that becomes more valuable the more you use healthcare.

There is no universally right answer. The right answer depends on your specific doctors, medications, health history, budget, and how you prefer to manage financial risk.

2026 Key Numbers for LA County Residents

Cost/Feature	2026 Figure
Part A hospital deductible	$1,736 per benefit period
Part B monthly premium	$202.90/month
Part B annual deductible	$283
Part B coinsurance (Original Medicare)	20% with no annual cap
SNF coinsurance (days 21–100)	$217.00/day
Part D annual out-of-pocket cap	$2,100
Part D max annual deductible	$590
Medicare Advantage MOOP ceiling (national)	$9,250
Average MA MOOP in LA County	$2,428
MA plans available in LA County	74
MA plans with $0 premium	65 of 74
MA enrollment in LA County	~559,063
Annual Enrollment Period	October 15 – December 7
MA Open Enrollment Period	January 1 – March 31
California Birthday Rule window	60 days starting on your birthday
HD Plan G deductible	$2,950

Enrollment Windows — The Deadlines That Matter

Initial Enrollment Period (IEP) Seven months — starts 3 months before the month you turn 65, includes your birthday month, ends 3 months after. This is your first and most important window. Missing Part B enrollment triggers a permanent 10% penalty per 12-month period you were eligible but didn’t enroll.

Special Enrollment Period (SEP) If you’re still working at 65 and covered by an employer plan, you can delay Medicare without penalty. The moment you retire, you have 8 months to enroll. COBRA and retiree health plans do NOT count as current employer coverage — the SEP applies only to active employer coverage.

Annual Enrollment Period (AEP) October 15 – December 7 each year. Switch Medicare Advantage plans, switch between Original Medicare and MA, or change your Part D plan. Changes take effect January 1.

Medicare Advantage Open Enrollment Period (OEP) January 1 – March 31. One-time opportunity to switch MA plans or return to Original Medicare.

California Birthday Rule Within 60 days of your birthday each year, switch Medigap plans (same or lesser benefits) with no medical underwriting. Your annual protected window to shop Medigap rates.

Frequently Asked Questions

What’s the best Medicare Advantage plan in Los Angeles County for 2026? There isn’t a single best plan — it depends on your doctors, your health needs, and which hospital network serves your neighborhood. Kaiser is the most enrolled plan with 180,321 members, and its integrated model works exceptionally well for people who want everything in one system. SCAN is the leading non-Kaiser HMO with deep LA County roots and strong star ratings. The right plan for you depends on your specific providers and ZIP code.

Is Medicare Advantage or Medigap better in LA County? For generally healthy people who want to minimize monthly premiums and stay within a strong local hospital network — Medicare Advantage. For people managing complex conditions, seeing multiple specialists, traveling, or wanting complete provider freedom — Medigap. LA County’s average MA MOOP of $2,428 makes Advantage particularly competitive here, but that number only matters if you stay in-network.

What is the California Birthday Rule and how do I use it? California law allows Medigap policyholders to switch to another plan with equal or lesser benefits — without any health questions or medical underwriting — within 60 days of their birthday each year. You can use this right every year to shop for lower premiums. You cannot upgrade to a plan with more benefits using the Birthday Rule. Mark your birthday on the calendar 45-60 days in advance and review your Medigap rates at that time each year.

Do I need Part D if I have Medicare Advantage? Almost certainly not — 71 of 74 LA County Medicare Advantage plans include prescription drug coverage. Only 3 plans in the county exclude Part D. If you enroll in one of those 3 rare MA plans without drug coverage, you’ll want to add a standalone Part D plan. Check your specific plan’s benefits before assuming drug coverage is included.

What does Medicare Advantage cost me when I actually use care in LA County? The average out-of-pocket maximum in LA County is $2,428 — meaning the most you’d pay for in-network covered services in a calendar year is approximately $2,428 before the plan covers 100%. This is dramatically below the $9,250 national ceiling. However, your actual costs depend on your plan’s specific copays for doctor visits, specialist visits, hospital stays, and outpatient procedures. Always review the Evidence of Coverage for your specific plan.

Can I see any doctor I want with Medicare in LA County? With Original Medicare + Medigap: yes, any doctor anywhere in the country who accepts Medicare. With Medicare Advantage: only providers in your plan’s network (for HMO plans) or at lower cost-sharing within the network (for PPO plans). In LA County’s competitive market, most major hospital systems are covered by multiple carriers — but Kaiser is an important exception. Kaiser only participates in Kaiser plans.

What should I do first before choosing a Medicare plan? Before you look at a single premium, make a list of every doctor and specialist you currently see, every hospital you’d want access to, and every medication you take. Then verify provider network participation and drug formulary coverage against each plan you’re considering. An independent broker can do this verification for you at no charge.

Ready for a Real Conversation About Your Specific Situation?

This guide gives you the landscape. But the right plan for your specific doctors, prescriptions, neighborhood, and budget requires a real conversation — not a generic recommendation.

I’m an independent broker. I represent 40+ carriers. I have no quota, no commission override that pays me more for one company than another. I’ll show you every option that fits your situation and give you my honest take on what makes the most sense.

That conversation is always free.

Paul Barrett, CMIP The Modern Medicare Agency 631-358-5793 medicare@paulbinsurance.com paulbinsurance.com

Licensed in 37 states | Independent | 18+ years Medicare-exclusive experience | 5,000+ clients

Related LA County Guides:

Primary Sources:

Disclaimer: The Modern Medicare Agency is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Plan data reflects CMS-published figures and third-party sources current as of July 2026. Always verify current plan details at Medicare.gov or call 1-800-MEDICARE before making any coverage decisions.

Medicare in Los Angeles County: The Complete 2026 Guide

THE CORE CHOICE: MEDICARE ADVANTAGE OR MEDIGAP

The Foundation: What Medicare Actually Is in 2026

The Three Paths in LA County