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 2023, 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 $350, from $7,050 to $7,400 in 2023.
You will also face higher out-of-pocket costs in 2022 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $480 in 2022 to $505 in 2023, while the initial coverage limit is increasing from $4,430 in 2022 to $4,660 in 2023.
For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs. Manufacturers provide a 70% discount on brands and plans pay the remaining 5% of costs for brand name drugs. Plans pay the remaining 75% of generic drug costs. For total drug costs above the catastrophic threshold, Medicare pays 80%, plans pay 15%, and enrollees pay either 5% of total drug costs or $4.15/$10.35 for each generic and brand-name drug, respectively.
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 with annual incomes of less than $20,385 and financial resources of up to $15,510, or married couples with incomes of less than $27,465, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
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.
By contacting the phone number on this website you will be directed to a licensed agent.
- Pre-65 Health Insurance
- The Parts of Medicare
- Medicare Enrollment Periods
- Penalties & IRMAA
- Medicare 2023 costs at a glance
- Two Paths to Consider
- What is Medicare Supplement (Medigap) Insurance?
- Part D Prescription Drug Plans
- Part C - Medicare Advantage Plans
- Part C - Special Needs Plans (SNP)
- Medicare Resources