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California State FlagMedicare Part D Plans in California

If you’re getting ready to enroll in Medicare due to a disability or because you’re turning 65, it’s essential that you learn how Medicare Part D works. In California, like the rest of the country, Part D is optional but highly recommended. Medicare Part D helps people living in California afford their prescription drugs rather than paying the entire price out of pocket.

Understanding Medicare Part D

Medicare Part D coverage is available in California from Medicare plans offered by private insurance companies that have contracted with Medicare to provide prescription drug coverage. The medications covered and the monthly premium for each plan tend to vary depending on the insurance company and the service area you live in.

Obtaining Medicare Part D Coverage in California

In California, you can enroll in a Medicare Part D prescription drug plan as long as you are enrolled in Original Medicare (Parts A and B). If you stick with Original Medicare, you can then purchase a stand-alone prescription drug plan to provide your prescription benefits. If you choose Medicare Part C, also known as Medicare Advantage plans, you can choose a plan that includes prescription drug coverage.

For those who choose Medicare Part C or Medicare Advantage, you’ll need to make sure you select a plan which includes prescription drug coverage. Not all plans come with prescription drug coverage, so it’s important that you compare plans and choose one that does. If you choose a  Medicare Advantage plan and a stand-alone prescription plan, you will be automatically disenrolled from the Medicare Advantage plan and you’ll be transitioned back to Original Medicare.

When Should I Sign Up for Prescription Drug Coverage?

In order to qualify for Medicare Part D, you have to be enrolled in Original Medicare. If you are, then there are several time periods when you can sign up for a prescription drug plan.

The first opportunity you have to sign up for Part D prescription coverage in California is during the Initial Enrollment Period. This begins three months before your 65th birthday, continues during the month of your birthday, and concludes three months after your birthday. This is when you can choose to stay with Original Medicare and a enroll in a stand-alone prescription drug plan or choose a Medicare Advantage all-in-one plan that includes prescription drug coverage.

During the Annual Election Period, you can change from one stand-alone Part D plan to another, switch from Original Medicare to Medicare Advantage, and change from Medicare Advantage to Original Medicare with a stand-alone Part D plan. This goes from October 15 to December 7 each year.

During Medicare Advantage Open Enrollment, you can change from one Medicare Advantage Drug plan to another or switch back to Original Medicare and purchase a stand-alone prescription drug plan. This occurs from January 1 through March 31.

Beyond these times, if you have a special circumstance in your life that requires you to switch plans, you will be eligible for a Special Election Period. Special circumstances include moving outside of your insurance coverage area or losing coverage through no fault of your own.

What Is Covered Under a Medicare Part D Prescription Drug Plan?

Both stand-alone Medicare Part D prescription drug plans and Medicare Advantage prescription drug plans are provided by private insurance companies in California contracted by Medicare. Because of this, the coverage and cost of plans can tend to vary. It’s essential to compare plans and be sure that the plan you choose covers all the medication you need and is budget friendly.

Each plan has a different list or formulary of prescription drugs that are covered. Be sure to view this list and make sure your medications are included. These formularies can change from year to year, and if they do, the insurance company will notify you and cover any prescriptions you have for the rest of the coverage year, even if they are removed from the list. The next coverage year, however, you’ll need to choose a different plan if you want to continue receiving these cost-savings for your prescriptions.

No matter which plan you choose, you’ll end up spending far less even with your monthly deductible and copay than you would without Part D insurance.

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