2021 Medicare Prescription Drug Plan Changes in California
California seniors, you have more Medicare Part D plan (PDP) choices this year. Also, you'll find 2021 plans with lower monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ..., however, the initial A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.... is now as much as $445 per year, a $10 increase over last year. This increase is offset by a higher Initial Coverage Limit, which increased to $4,130. What follows will guide you through what you need to know to get the best Part D prescription drug plan available in California with affordable Out-of-pocket costs (aka, out-of-pocket medical expenses) are costs that a beneficiary must pay because their health insurance does not cover them. Out-of-pocket costs are found in the deductibles, copayments, and coinsurance outlined in each health....
2021 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 2021 prescription drug plan with a standard initial deductible, you'll spend $10 more out-of-pocket in 2021 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.
2021 Medicare Part D Initial Coverage Limit (ICL)
The 2021 Initial Coverage Limit (ICL) is $4,130. The Coverage Gap (donut hole) starts when you reach the ICL and ends when you hit the out-of-pocket threshold, which is now $6,550. 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.
Will You Fall Into The 2021 Donut Hole?
An easy way to estimate if you will run out of coverage is to look at the average monthly cost of your medications. If your prescriptions have an average retail value of over $335 per month, you will enter the 2021 Donut Hole at some point in the year. This assumes that your current retail drug prices remaining stable.
The 2021 Donut Hole Discount is 75% for Generic Drugs
If you reach the 2021 Coverage Gap phase of your Part D coverage, the generic drug discount will be 75%. 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 2021 Donut Hole Discount is 75% for Brand-Name MedicationsThe 2021 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 2021 total out-of-pocket maximum or Donut Hole exit point.
Some plans offer additional gap coverage, so look for it on the plan information pages.
How Much Will You Spend To Exit The Donut Hole in 2021?
Your Total Out-of-Pocket Cost (TrOOP) threshold will increase to $6,550 in 2021. That's $200 more than the 2020 TrOOP limit of $6,350. 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.
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 formulary. 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.
Did you Know Most California Medicare Advantage Plans Include Prescription Drug Coverage?
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 Part D is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.... listed above. The second way to get help paying for your prescriptions is through one of the California Medicare Advantage Plans that include Part D.
Medicare Part D and Supplements Work Together
Thinking about supplemental insurance that can offer you more coverage? It's a smart move. Even with the new health care law, Medicare only covers 80 percent of the hospital and doctor bills incurred by most seniors in the great state of California, leaving you to handle the rest. We make it easy to find the lowest price on the California Medicare Supplement, commonly called a Medicare 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.... plan, you want. The choice is yours, because all Medicare Part D plans are compatible with California Medigap plans.
Medicare Part D for Dual Eligible People in California
California seniors who qualify for both Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.... (aka, dual eligible or Medi-Medi) may be enrolled in a California Medicare Prescription Drug Plan automatically, as well as Social Security's Extra Help program. The Extra Help program pays for most of your prescriptions, but only if you meet the strict eligibility requirements. If the dual eligible option does not meet your needs, you have the option to enroll in a California Part D plan that does. If you are already receiving Medicaid, contact your local Medicaid office for assistance in the transition to Medicare.
Frequently Asked Questions About California Medicare Part D Plans
What is best for you may not be best for someone else. It all has to do with where you live and your regular prescriptions. These are some of the top plans in 2021:
The average cost of a Medicare Part D plan in 2021 is about $32. Be aware, though, that this figure is slightly different depending on where you live. The good news is that basic plans start near $20 per month. To check out your options in California, browse to this page.
Medicare Part D plans change annually and they are different in each state. You can see all of the plans available in California on this page.
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 is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... and Medicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care...., 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.
Citations & Referencesmedicare.gov
- What Medicare Part D drug plans cover | Medicare https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans...
- Medicare.gov: the official U.S. government site for Medicare | Medicare https://www.medicare.gov/
- CMS 1696 | CMS http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS012207.htm...
- MACRA: MIPS & APMs | CMS https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instrumen...
- An Overview of the Medicare Part D Prescription Drug Benefit | KFF https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-pr...
- Medicare Part D: A First Look at Prescription Drug Plans in 2020 – Issue Brie... https://www.kff.org/report-section/medicare-part-d-a-first-look-at-prescripti...
- 10 Things to Know About Medicare Part D Coverage and Costs in 2019 | KFF https://www.kff.org/medicare/issue-brief/10-things-to-know-about-medicare-par...
- Home | State Health Insurance Assistance Programs https://www.shiptacenter.org/