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Guide to Medicare Part D

I have Medicare & Full Medi-Cal
(if No – go back)

If you are enrolled in Medi-Cal without a Share of Cost and are also covered by Medicare, your prescription drug benefit will be eliminated from Medi-Cal on January 1, 2006, and replaced by Medicare Part D.

I have Medicare AND full Medi-Cal ONLY*

2005 TIMELINE

May – You should have received a letter describing the new Medicare Part D Prescription Drug Coverage that will replace your Medi-Cal drug coverage, and notification that you are automatically eligible for extra help with drug plan costs.

October 15 – You will be automatically assigned to a Medicare Part D Prescription Drug Plan on this date. Not all plans will cover all medications, so review your assigned plan carefully. You may need to switch to a different plan that is right for you according to your medication needs.

December 31 – Last date to change to a different Medicare Part D plan and get coverage without interruption in January.

January 1, 2006 – Drug coverage under Medi-Cal ends and Medicare Part D coverage begins.

COVERAGE

Premium – Covered (for plans at or below the average premium price in California)

Deductible – none

Co-payment – $1-5 per prescription/refill (depending on your income level)

“Donut Hole” – Covered

Catastrophic Coverage – Covered
NOTE: Plans may offer drugs in a “tier” system with higher co-pays for certain medications. You may have to pay these out-of-pocket costs yourself.

* If you have Medi-Cal with a “Share-of-Cost,” call HICAP for more information at 1-800-434-0222

 


HICAP
Health Insurance Counseling and Advocacy
 
Mission
 

To provide accurate and objective counseling, advocacy, and assistance with Medicare, health insurance, and related health coverage plans for Medicare beneficiaries, their representatives, or persons imminent of Medicare eligibility, and to educate the public on Medicare and health insurance issues.
 
Origins
 

The 1984 State legislation established HICAP under the Department of Aging.
 
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