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Medicare Part D Coverage in California

Individuals on Medicare are eligible for prescription drug coverage under a Part D coverage plan in California if they are signed up for benefits under Medicare Part A and/or Part B. You must enroll in Medicare Part D separate from Medicare Parts A and B.

How to Get Medicare Part D Coverage in California

You can purchase a Prescription Drug Plan from an independent insurance agent who contracts with Medicare. In California, there are about 30 prescription drug plans for Medicare patients. Each plan has its own premium and a yearly deductible which varies depending on the insurance provider

When searching for the right prescription drug plan, consider the following:

  • Are you currently taking prescription medication?
  • Do you pay for high-cost prescriptions?
  • Do you pay for generic drugs?

The answers to these questions can help you determine the right plan. If you are currently taking medication, for example, you should check each plan’s formulary list and verify whether or not the drug you take is on the list. That can help narrow down the plan that’s right for you.

If you take generic drugs, you may want a plan that offers a low co-pay for generic drugs. If you take high-cost prescriptions, you’ll want to consider plans that offer a “coverage gap.” This helps with out-of-pocket-expenses when paying for prescription drugs.

Signing Up for Medicare Part D Coverage in California

You must be enrolled in a Medicare plan to be eligible for Medicare Part D. This includes Medicare Part A and/or B. You must also choose a Medicare Part D plan that services your area.

Note that Medicare Part D isn’t automatic. It’s an optional insurance, but there’s a catch.

If you think you’ll want Medicare Part D Coverage in California, you’ll want to sign up for it as soon as you’re eligible. Medicare charges a late enrollment penalty if you don’t enroll during your eligibility period. You have seven months to enroll in Medicare. This timeline starts three months before your 65th birthday, the entire month of your birthday, and three months following your birthday month.

If you do not sign up for Medicare Part D during the eligibility period, and you go without creditable prescription coverage for 63 or more days in a row, you may be subject to a penalty once you decide to enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan. This penalty lasts for the duration of your Medicare Part D program.

Understanding the Medicare Part D Penalty

Medicare charges one percent of the national premium for Medicare Part D per month, for every month that you don’t have creditable prescription coverage. Creditable coverage includes prescription plans from an employer or union. It also includes coverage from any other Medicare plan, such as Medicare Advantage. You must provide proof of coverage to avoid the penalty.

For example, if you were without prescription coverage for 20 months, your penalty would be 20 percent. Medicare would charge you 20 percent of the national base beneficiary premium for that year. You pay this penalty for your lifetime, or as long as you have Medicare coverage.

Medicare Part D in California Open Enrollment

If you miss your chance to enroll in Medicare Part D Coverage in California during your initial period, you have other chances. Medicare offers Part D coverage during the annual open enrollment period from October 15 to December 7. You can change your plan for the following year during this time.

Other Options for Prescription Drug Coverage

Medicare Part C, or Medicare Advantage, is another way to obtain prescription drug coverage. Medicare Advantage is an HMO or PPO plan that includes prescription drug coverage. Independent insurance agents offer these plans while contracting with Medicare. They offer the same coverage as Medicare Parts A and B along with prescription drug coverage.

Some people prefer Medicare Advantage plans as it encompasses all your coverage in one insurance plan, which may be easier to manage or coordinate. In addition, it offers more flexibility when choosing doctors and hospitals. You are free to change from or to Medicare Advantage during the open enrollment period each year.

Medicare Part D Coverage in California is one way to get help with your prescription drug costs. It’s best to look at all your options and revisit them yearly. As your medical and prescription drug needs change, so may your insurance needs. At the very least, consider enrolling in Part D initially to avoid the penalty fee.

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