26 Best Medicare Part D Plans in California for 2023

We found the 26 best Medicare Part D Plans in California for 2023.

We also ranked the best Medicare Advantage plans with Part D in California for 2023.

Every Part D Plan in California Has 4 Cost Phases

California Medicare prescription drug plansMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... help beneficiaries pay for their prescription medications. If you are new to Medicare, some of the Part D plan concepts may be foreign to you. So we'll start with an overview of the four cost-sharing phases.

Phase 1 is the Deductible

The deductible (up to $505 in 2023) is the amount that you pay before your Medicare Part D plan begins paying its share of the costs. So, if you enroll in a 2023 prescription drug plan with a $480 deductible, you'll spend $480 out-of-pocket before cost-sharing coverage begins. Most Medicare Part D plans have a deductible, but some Medicare Part D plans exclude Tier 1 drugs from the deductible, giving immediate coverage on most generic medications.

The 2nd Phase is the Initial Coverage Limit (ICL)

For 2023, the Part D Initial Coverage Limit (ICL) is $4,660. Your Part D plan will pay the bulk of your prescription cost during the ICL phase. If your costs exceed $4,660, then you will be in the coverage gap phase (aka "doughnut hole")

Phase 3 is the Coverage Gap

After your gross drug costs have reached $4,660, you will enter the Coverage GapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. phase. This is where you will pay 25% of your medication's retail cost. While the price of generic drugsA generic drug is a prescription medication that has the same active ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. might not be much different, what you pay for brand-name drugs will be higher (because you're paying 25% of the full price). This will continue until you reach $7,400 in True Out Of Pocket Costs (TrOOP).

Some plans offer additional gap coverage, so look for it on the plan information pages.

Catastrophic Coverage is the Fourth Phase

All Part D plans offer catastrophic coverage once you have paid $7,400 in true out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. for covered drugs. This amount includes the cost of covered drugs as well as some additional costs. In the catastrophic coverage phase, your copaysA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. or coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  will be significantly lower for the remainder of the year.

The out-of-pocket costs that help you get catastrophic coverage include:

1. Your plan's deductible;
2. What you paid during the initial coverage limitOnce you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut... period;
3. Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
4. The amount paid by others, including family members, most charities, and other persons on your behalf; and
5. The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.

The Lowest Premium May Not Be the Lowest Overall Cost

Evaluate Part D Medicare plans wisely. If you have a regular prescription or two, we suggest that you verify that the plan you want offers your medication(s) at a good price. You find this information in the formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. We post links to the formulary and pharmacy web pages, as well as the plan's phone number, on each of the PDP pages listed above.

IMPORTANT: Identifying the best Medicare Part D Plans for you takes a bit of research. What's best for you is personal and must consider multiple factors, including your regular prescriptions, your health, and your finances.

Get Your Prescriptions and More with a Medicare Advantage Plan

There's more than one way to get prescription drug coverage with your Medicare benefits. The first way is by enrolling in one of the Medicare prescription drug plans available in California. The second way is to get prescription coverage through one of the many California Medicare Advantage Plans that include Part D benefits. Most Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). available in California include Part D as an additional benefit.

Combining a Medicare Supplement and Medicare Part D Benefits

With Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. you are responsible for paying about 20 percent of all hospital and medical bills. Without additional protection, even a brief hospital stay can cost you thousands out-of-pocket. That's why we maintain a complete directory of California Medicare Supplement Insurance, also known as Medigap. We make it easy to find the best rates on the coverage you want. All Medicare supplementsMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. sold in California plans are 100% compatible with Medicare Part D plans.

Medicare Part D for Dual Eligible People in California

If you meet the requirements for both Medicare and Medicaid (aka, "dual eligible" or "Medi-Medi") in California, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra Help, the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. now, call your local Medicaid office for assistance with your dual eligible benefits.

Citations & References

1. Medicare.gov, "How to get prescription drug coverage", Last Accessed September 3, 2022
2. Medicare.gov, "How Part D works with other insurance", Last Accessed July 14, 2022
3. Medicare.gov, "Catastrophic coverage", Last Accessed June 13, 2022
4. Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed June 7, 2022
5. SSA.gov, "Extra Help with Medicare Prescription Drug Plan Costs", Last Accessed June 1, 2022
6. CMS.gov, "Landscape Source Files", Last Accessed January 15, 2023
7. CMS.gov, "Medicare Part C & D Performance", Last Accessed January 15, 2023

This Medicare Part D plan state information page was last updated on January 19, 2023.