Medicare Broker in Encinitas: From Leucadia to Olivenhain, a Plan Built Around Your Doctors

Encinitas is really five communities in one: Old Encinitas and downtown along the 101, Leucadia to the north, Cardiff-by-the-Sea to the south, New Encinitas around El Camino Real, and the larger lots of Olivenhain in the eastern hills. The people we talk to here are just as varied. Some are retiring from long corporate careers. Many are self-employed, from consultants and designers to small business owners on the 101, and have been buying their own health insurance for years. Others spend a few months each year traveling and want coverage that comes with them.

Brian McArthur, an independent licensed Medicare broker and creator of the Medicare Execution Process®, helps Encinitas residents and their financial advisors choose Medicare coverage that fits how they actually live and which doctors they already see. Our office is in Escondido, about 25 minutes east via Highway 78 or San Elijo Road.

Health care in and around Encinitas

  • Scripps Memorial Hospital Encinitas: the full-service hospital on Santa Fe Drive, with the city’s emergency room.
  • Scripps Coastal Medical Center Encinitas: primary care and outpatient visits.
  • Scripps Clinic Carmel Valley and Scripps Memorial Hospital La Jolla: specialty care, surgery, and cardiac and cancer treatment, about 20 minutes south.
  • UC San Diego Health: academic medicine, clinical trials and complex cases.
  • Tri-City Medical Center: in Oceanside, used by some residents in north Leucadia.

With Original Medicare, you can use any doctor or hospital that accepts Medicare. With Medicare Advantage, the doctors and hospitals you can use depend on the plan’s network and, for HMOs, your medical group. Those networks are set by each plan and can change from year to year. We check whether your doctors and hospitals are in a plan’s network before you enroll, and again each fall.

Self-employed? Leaving Covered California at 65

A lot of Encinitas residents reach 65 on an individual plan through Covered California. That plan does not end on its own when Medicare starts, so you need to cancel it yourself once your Medicare coverage is in place. If you’ve been getting a premium tax credit, you generally stop qualifying for it once you’re eligible for premium-free Part A, so keeping the old plan can mean paying it back at tax time.

Timing matters here. Your Initial Enrollment Period runs seven months around your 65th birthday month. If you sign up in the three months before your birthday, Medicare can start on the first of your birthday month, so there’s no gap. We map out the dates with you, so the Covered California plan ends the day Medicare begins.

If you’re self-employed and still working past 65, you don’t have employer coverage to delay Part B with, so most people in that situation enroll on time to avoid a late penalty.

Turning 65 in Encinitas: other timing to know

  • Still working for a large employer? You may be able to delay Part B without a penalty if your coverage is creditable.
  • HSA contributions: these must stop once you’re enrolled in any part of Medicare.
  • Medigap open enrollment: six months starting with your Part B effective date, when you can buy any Supplement without health questions.
  • California’s birthday rule: each year around your birthday, you can move to a Supplement with equal or lesser benefits without medical underwriting.

G for great, N for nice: choosing a Supplement

If you choose Original Medicare, a Medicare Supplement (Medigap) pays much of what Medicare doesn’t. Two plans cover most of the choices we see:

  • Plan G: pays your share of Medicare-approved costs, except the annual Part B deductible ($283 in 2026). After that, you have no copays for covered services.
  • Plan N: a lower monthly premium. You pay the Part B deductible, plus small copays for some office and emergency room visits.

You’ll also want a Part D drug plan alongside your Supplement. In 2026 the standard Part B premium is $202.90 a month, and Supplement and Part D premiums are added on top. Supplements work with any provider in the country that accepts Medicare, which matters if you travel or spend part of the year somewhere else.

When Medicare Advantage fits

Medicare Advantage can work well for someone who is comfortable with a network, happy to have a primary care doctor coordinate referrals, and wants drug coverage in a single plan. The trade-offs are network limits and prior authorization for some services, and care outside your area is often limited to emergencies and urgent care. Premiums, copays and networks vary by plan and by year. We compare the specific plans we offer in San Diego County using your doctors and prescriptions.

If you’re in an individual Sharp Health Plan Medicare Advantage plan, note that Sharp Health Plan has announced it will no longer offer individual Medicare Advantage plans in 2027. Coverage stays active through December 31, 2026, and we can help you compare options.

IRMAA and uneven income

Self-employed and business-owner income often goes up and down. IRMAA, the income surcharge on Part B and Part D, is based on your tax return from two years earlier, so a strong business year or a business sale can raise your premiums later. It starts above $109,000 for single filers and $218,000 for married couples filing jointly. If your income dropped because you stopped working, Form SSA-44 lets you ask Social Security to recalculate. We coordinate with your financial advisor or CPA.

How we work with Encinitas clients

Design My Medicare has helped with more than 1,500 Medicare enrollments for clients in 46 states, and North County is home.

The first call is 30 minutes, free and with no obligation:

  • We list your doctors and the hospital you prefer.
  • We set up the timeline for ending a Covered California or employer plan.
  • We look at your income picture for IRMAA.
  • We compare a Supplement and Medicare Advantage using real numbers.
  • We match a drug plan to your prescriptions.
  • We review your coverage every fall during the Annual Enrollment Period.

Frequently asked questions

Does Scripps Memorial Hospital Encinitas accept Medicare?

Scripps Encinitas accepts Original Medicare, so with Original Medicare and a Supplement you can use it like any Medicare-participating hospital. With Medicare Advantage, it depends on the plan’s network and medical group for that year. We check your doctors for you.

I have a Covered California plan. When should I cancel it?

Cancel it so it ends the day before your Medicare starts. If you enroll in the three months before your 65th birthday month, Medicare usually starts on the first of that month. We help you line up the dates.

I’m self-employed and still working. Can I delay Medicare?

Usually not without risk. The Part B delay applies to people covered through an employer (or a spouse’s employer) based on current employment. Self-employed people with individual plans generally need to enroll during their Initial Enrollment Period to avoid a penalty.

I travel for several months a year. Which type of coverage handles that?

Original Medicare with a Supplement works with any provider in the U.S. that accepts Medicare. Some Supplements also include limited foreign travel emergency coverage. Medicare Advantage networks are usually local, apart from emergency and urgent care.

Do you work with people in Cardiff, Leucadia and Olivenhain?

Yes, we work with clients across all of Encinitas and nearby Solana Beach, Rancho Santa Fe and Carlsbad.

Is there local help for seniors in Encinitas beyond Medicare?

The Encinitas Community and Senior Center on Oakcrest Park Drive offers classes, activities and resources. We’re happy to point you to local help for other questions too.

Book a 30-minute Medicare call

Live in Leucadia, Cardiff, Olivenhain or anywhere in Encinitas and getting close to 65? Book a 30-minute call with Brian McArthur. We’ll cover your doctors, your timeline and which type of coverage fits.

Book your call at go.designmymedicare.com/brian

Phone: (619) 374-0096

Neighbors can read our Carlsbad, Del Mar and Rancho Santa Fe pages, or see Medicare Advantage vs. Medicare Supplement. Nearby areas we serve: Carlsbad, Solana Beach and Rancho Santa Fe. If your Medicare Advantage plan is ending, see what to do if you are losing your Medicare Advantage plan in 2027 and your options and deadlines when a Medicare Advantage plan ends.

Brian McArthur is a licensed insurance agent. Design My Medicare® and the Medicare Execution Process® are registered trademarks. Premium figures cited are 2026 standard amounts published by CMS; individual premiums vary based on income (IRMAA), plan choice, and carrier. Not connected with or endorsed by the U.S. government or the federal Medicare program.