2020 Medicare Prescription Drug Plan Changes in California
California seniors, you have more Medicare Part D plan (PDP) choices this year. Also, you'll find 2020 plans with lower monthly premiums, however, the standard initial deductible is now $435 per year, a $20 increase over last year. This increase is offset by a higher Initial Coverage Limit, which increased to $4,020.
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.
Will You Fall Into The 2020 Donut Hole?
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.
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 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.
Don't make a decision on your choice of Part D Medicare plans based on the premium and deductible alone. It's critical that you verify that your medications are covered. You find this information, and the co-payment tiers, in the formulary. On each PDP page (above) we post links to the formulary and pharmacy web pages, and the phone numbers to contact the plan.
VITAL: Identifying the best Medicare Part D Plans requires research. What works the best for you is all about your regular prescriptions (if any), your health and what you can afford.
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.
Medicare Part D and Supplements Work Together
Medicare does not pay for all of your hospitalization and doctor bills. Even with the new healthcare law fully in place, your Original Medicare only pays about 80 percent of your California healthcare bills. We keep an up-to-date catalog of California Medigap Plans, also call a Medicare Supplement, with the tools you need to find the best price and coverage. The Medicare PartD plans above are fully compatible with California supplemental insurance.
Getting Medicare Part D with California Medicaid
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 Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.
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.