Changes to 2020 Medicare Part D in California
People with Medicare benefits in California have more Medicare Part D Plan (PDP) choices in 2020. However, the standard initial deductible is now $435, up from $415 last year, a $20 increase over last years' standard deductible. The Initial Coverage Limit has increased to $4,020, a 5% bump over last year.
2020 Medicare Part D Standard Initial Deductible
The initial deductible 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 2020 prescription drug plan with a standard initial deductible, you'll spend $20 more out-of-pocket in 2020 before coverage begins. Most Medicare Part D plans have an initial deductible, but many popular Medicare Part D plans exclude Tier 1 and Tier 2 drugs from the deductible, giving immediate coverage on most lower-cost medications.
Part D Initial Coverage Limit (ICL)
The 2020 Initial Coverage Limit (ICL) is $4,020, a 5% jump over last year. The Coverage Gap (donut hole) starts when you reach the ICL and ends when you spend a total of $5,100. The Initial Coverage Limit marks the coverage gap entry point. You enter the coverage gap when the total negotiated retail value of your prescription drug purchases exceed your plan’s Initial Coverage Limit.
2020 Coverage Gap (Donut Hole) Details
An easy way to estimate if you will run out of coverage is to look at that average monthly cost of your medications. If your prescriptions have an average retail value of over $335 per month, you will enter the 2020 Donut Hole at some point in the year. This assumes that your current retail drug prices remaining stable.
The 2020 Donut Hole Discount is 75% for Generic Drugs
If you reach the 2020 Coverage Gap phase of your Part D coverage, the generic drug discount will be 75% (up from 63%). This means your generic drug costs in the Donut Hole will be 25% of your Part D plan's negotiated retail prices. What you pay counts towards your true out-of-pocket costs (This amount counts toward your TrOOP).
The 2020 Donut Hole Discount is 75% for Brand-Name MedicationsThe 2020 brand-name Coverage Gap discount remains the same at 75%. The pharmaceutical industry is responsible for picking up 70% of the cost of medications for beneficiaries in the Donut Hole. You get credit for 95% of the retail drug cost toward meeting your 2020 total out-of-pocket maximum or Donut Hole exit point.
How Much Will You Spend To Exit The Donut Hole in 2020?
Your Total Out-of-Pocket Cost (TrOOP) threshold will increase to $6,350 in 2020. That's $1,275 more than the 2019 TrOOP limit of $5,100. TrOOP is the dollar amount you'll spend to get out of the Donut Hole or Coverage Gap and into your Medicare Part D plan's Catastrophic Coverage phase.
It's important to remember that TrOOP doesn't include your monthly premiums or over the counter purchases. Some plans offer additional gap coverage, so look for it on the plan information pages.
Choose from the available Part D Medicare plans carefully, and don't settle on a Part D plan until you know that your most expensive medications are covered at a price you can afford. This information is available in the plan's formulary. You'll find links to the formulary information, pharmacy information, and the customer service phone number on each PDP page (above).
CRITICAL: The best Medicare Part D Plans for you can only be determined by factoring in what you can afford, your regular prescriptions and your health. A bit of time spent on research will pay off in the long run.
Get Your Prescriptions and More with a California Medicare Advantage Plan
Medicare realizes that one type of plan does not suit everyone. That's why there are two ways to get help with your prescriptions. The Medicare Prescription Drug Plans above work with Original Medicare. That's one way. But maybe you'd like even more benefits. That's where California Medicare Advantage Plans come in. Most offer Part D coverage.
Combining a Supplement and Medicare Part D Benefits
The new healthcare law did not change the coverage you get from Medicare for major medical. You are still responsible for paying the remaining 20 percent of all hospital and doctor bills. Even a brief hospital stay can cost you thousands. That's why we maintain a complete catalog of California Medicare Supplement Insurance, also known as Medigap. We make it easy to find the best price on the plan you want. All Medigap plans are 100% compatible with the Medicare Part D plans listed above.
Medicare Part D for Dual Eligible People in California
In California, if you are eligible for both Medicare and Medicaid (aka, dual eligible or Medi-Medi) you will automatically be enrolled in a California Medicare Prescription Drug Plan and the Social Security Extra Help program. Extra Help pays for most of the costs of your prescriptions if you meet the eligibility requirements. You may also enroll in a plan of your own choosing that better meets your needs. If you qualified for Medicaid before you were eligible for Medicare, contact your local Medicaid office.
Best California Medicare Part D Plans
Each year we highlight the California PDP's with the lowest cost, most members, and the best ratings. Below are the best 2020 Medicare Part D plans based on these metrics.
Lowest Costs PDP
- The cheapest California Part D Plan with no deductible is $34.80
- The cheapest California Part D Plan with a deductible ($435.00/year) is $12.80
Most Popular Nation-Wide PDP
- Blue Shield Rx Plus (0 national members)
- Blue Shield Rx Enhanced (0 national members)
- WellCare Classic (0 national members)
Most Popular Part D Plans in California
- Blue Shield Rx Plus (0 regional members)
- Blue Shield Rx Enhanced (0 regional members)
- WellCare Classic (0 regional members)
Most Popular Low-Income Subsidy Medicare Part D Plans
- WellCare Classic (0 national members)
- SilverScript Choice (0 national members)
- Cigna-HealthSpring Rx Secure (0 national members)
PDP Eligibility and Availability
You are eligible to enroll in a California PDP plan if:
- You are a resident of the state,
- You are enrolled in Medicare Part A and Medicare Part B, and
- You are age 65+ or have Medicare due to a qualifying disability.
All plans on this page are available to beneficiaries in Los Angeles, Long Beach, Anaheim, San Francisco, Oakland, Hayward, Riverside, San Bernardino, Ontario, San Diego, Carlsbad, Chula Vista, Sacramento, Roseville, San Jose, Sunnyvale, Santa Clara, Fresno, Bakersfield, Oxnard, Thousand Oaks, Ventura, Sonoma, Napa, Stockton, Irvine, and all rural areas of California.