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California Medicare Part D

California Medicare part D

Medicare Part D

Medicare Part D drug plans help with the cost of prescriptions. The government says they’re optional but in most cases if you don’t sign up for one when you turn 65 you will start to incur a 1% penalty for every month you don’t have one. So 12 months = 12% and it NEVER goes away! Does that sound like something that’s optional? Click here for details on the Part D LEP (late enrollment penalty)

Most California Medicare Advantage plans have Part D drug coverage but there are a few that don’t. Part D is not offered by the government but instead by private companies. They just have to make sure their plan is as good as Medicare’s model plan.

What pharmacies can I use?

Most plans use networks. Some networks may include many of the national chain pharmacies like Walmart, Walgreens, CVS, Rite Aide, etc. in addition to local pharmacies. Some may only include a few. Many of the plans offer mail order and give a discount for getting 90 day fills on prescriptions.

Coverage limits

Plans do vary greatly. Medications are grouped into Tiers and the price you pay will depend on what tier the drug is in. Each plan has a different copay structure for each tier. For 2013 when you reach $2970 in retail value you enter the “Donut Hole” or Coverage Gap. Click Here for a more detailed explanation. Keep in mind that you may have only paid $500 and the plan may have paid the other $2470. It’s the total retail value that gets you into the Donut Hole. Feel free to give us a call and we can explain it in more detail and help you find a Part D that’s right for you.

What isn’t covered?

You are covered for a certain medication only if it’s on the Medicare Part D plans formulary. Different plans cover different drugs and that’s why it’s important to take the time and choose wisely.


While some plans may cover the same drugs, monthly premiums can vary greatly. Some folks who didn’t sign up for Medicare Part D when they became eligible will have a Late Enrollment Penalty(LEP). Someplans will have a yearly deductible of $325 for 2103. There are plans that charge fixed copays while others charge a percentage of the medication while others make generics free of charge. If your plan offers coverage through the “Donut Hole” then you are able to just pay your copays while in the gap. On other plans you will pay 79% for generics and 50% for most brand name drugs while you’re in the gap.

When can I join?

As soon as you’re eligible for Medicare you can enroll in a Part D plan. Each year you have the ability to renew or change your plan during AEP which is October 15th through December 7th.

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