Part D Prescription Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.

It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don't have equivalent drug coverage from another source, such as a retiree plan.

Let us help you with your enrollment

If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year. Our quoting & enrollment tool lets you review many options and see how each plan works with your list of medications. Better yet, give us a call and let us help you review your options.

Making Part D work

In 2024, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will increase by $600, from $7,400 to $8,000 in 2024.

You will also face higher out-of-pocket costs in 2024 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $505 in 2023 to $545 in 2024, while the initial coverage limit is increasing from $4,600 in 2023 to $5,030 in 2024.

For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs. Although you'll pay no more than 25% of the price for the brand-name drug, almost the full price of the drug will count as out-of-pocket costs to help you get out of the coverage gap. What you pay and what the manufacturer pays (95% of the cost of the drug) will count toward your out-out-pocket spending.

Starting January 1, 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made by other people or entities, including Medicare’s Extra Help program, on your behalf), you’ll automatically get “catastrophic coverage.” This means you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs.

Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year

Call us to help you understand your options.

Getting financial help

Extra Help Program

Individuals or married couples with income and financial resources below a certain level might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.

Download Medicare's instructions on applying for the Extra Help program.

CA Prescription Drug Discount Program for Medicare Recipients

California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs.

Here’s how it works:

You must have a Medicare card, and show it to the pharmacy staff.
Give your prescription to the pharmacy staff, ask for the Medi-Cal prescription price, and ask if that is the lowest price the pharmacy will accept for the drug.
If the Medi-Cal price is lower, you can pay that price, plus a small processing fee of $0.15, for the prescribed drug.
You must pay for the prescription in full at the pharmacy: if you have prescription drug coverage, your insurance company is not eligible to receive the Medi-Cal price.
Only Medi-Cal provider pharmacies are required by law to offer and accept the Medi-Cal price as payment for prescription medication for Medicare recipients. However, non-Medi-Cal pharmacies may also offer the Medi-Cal price if they choose.

https://www.pharmacy.ca.gov/consumers/medicare_discount.shtml

This information was obtained from www.medicare.gov, www.ssa.gov, www.pharmacy.ca.gov

By contacting the phone number on this website you will be directed to a licensed agent.