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Medicare Part D Plans in California

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Medicare Part D Coverage in California

Medicare Part D coverage in California works in the same way as the rest of the country, providing prescription drug benefits to beneficiaries in the state. Those with Original Medicare can get prescription drug coverage by enrolling in a stand-alone Medicare Prescription Drug Plan, which works alongside their Medicare Part A and Part B coverage. Others may opt to enroll in a Medicare Advantage plan (Medicare Part C) that includes prescription drug benefits, also known as a Medicare Advantage Prescription Drug plan.

Medicare Part D coverage in California is available from Medicare plans that are offered through private insurance companies contracted by Medicare. The coverage and cost of each Medicare plan may vary, depending on the insurance company and the location that the plan is offered.

One important factor to keep in mind is that beneficiaries with Medicare Part C who want prescription drug coverage should enroll in a Medicare Advantage plan that includes this benefit. They should not enroll in both a Medicare Advantage Prescription Drug plan and a stand-alone Medicare Prescription Drug Plan; doing so will automatically disenroll them from the Medicare Advantage plan and return them to Original Medicare.

Enrolling in Medicare Part D coverage in California

To be eligible for Medicare Part D, you must have Medicare Part A and/or Part B and live the service area of the Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan that you’re considering.

There are a number of times when beneficiaries may enroll in Medicare Part D coverage in California. The first is the Initial Enrollment Period for Part D, which occurs when a beneficiary first becomes eligible for Medicare. The seven-month Initial Enrollment Period begins three months before the beneficiary becomes eligible for Medicare, includes the month of eligibility, and continues for three months afterward.

Beneficiaries may also enroll in or make changes to their Medicare prescription drug coverage during the Annual Election Period(AEP), also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 of each year. For beneficiaries who use the Medicare Advantage Open Enrollment Period(OEP) (January 1 to March 31) to disenroll from their Medicare Advantage plan, they will be returned to Original Medicare; they can also use this enrollment period to enroll in a stand-alone Medicare Prescription Drug Plan.

Beneficiaries may also be able make coverage changes outside of the regular periods with a Special Election Period, provided they have a qualifying situation (such as moving out of a plan’s service area).

Finding Medicare Part D coverage in California

Because Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans in California are offered by individual companies, there can be variations in coverage and plan cost. Beneficiaries interested in prescription drug coverage should carefully compare plans to find the one that offers the most comprehensive coverage at the best price. Before enrolling in any Medicare plan that includes prescription drug coverage, make sure your medications are included in the plan’s formulary, which is a list of the prescription drugs covered by the plan. Remember, formularies can change at any time; the Medicare plan will notify you when necessary. Also, keep in mind that Medicare plans with prescription drug coverage can have different cost-sharing structures, even to cover the exact same medications. Shopping around may help lower the out-of-pocket costs you pay for your medications.

If you have questions or need help finding Medicare plan options that cover your prescription drugs, contact eHealth today and speak to a licensed insurance agent to get personalized assistance with your needs.


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