If you will become eligible for Medicare benefits soon, you may be exploring your prescription drug coverage options. Even if you’re not currently taking many prescription medications, it’s a good idea to have some sort of coverage to prepare for the future. In most cases, it is most cost-effective to at least enroll in an inexpensive Medicare Part D plan to avoid the late-enrollment penalties that accrue over time and get added to your monthly premium. (We’ll dive into those penalty fees later in this article.)

The tricky part about finding the best Part D plan is that they are offered by private insurance companies, unlike Original Medicare (Medicare Part A and Medicare Part B), which is offered by the federal government at the same price point nationwide. So although Part D plans are regulated by the Centers for Medicare & Medicaid Services (CMS), you’ll find numerous plans that vary in coverage details, cost, and more—all depending on which insurer offers the plan.

Thankfully, online tools have made Medicare Part D comparison shopping easier. Let’s dive in.

The Insurify Medicare comparison tool can help you find a Medicare Part D plan with exceptional coverage. Shop, compare, and get the best deal today!

 

 

What Are the Best Medicare Prescription Drug Plans in California?

Like any other healthcare decision, determining what is considered the “best” can be very subjective. Since everyone has unique needs, there isn’t a universal answer that will apply to all. For example, if you don’t take medications often, you may lean toward a plan with a low monthly premium and a higher deductible. But if you do take many medications, a plan with no deductible may be more appealing.

There are 32 stand-alone prescription drug plans in California. Before comparing plan options, make sure to create a list of all your needs and preferences. Some questions you may want to ask yourself while shopping for a Medicare Part D plan are:

    • What does my monthly and annual budget look like for prescription medications? 
    • What prescriptions am I currently taking, and how often do I take them?
    • Do I have a family medical history that suggests I may need to take prescription medication in the future?
    • Does this plan’s formulary (a drug list of tiers that categorize medication types) cover any specific brand-name or specialty medications I may need? 

Once you’ve considered questions like these, you should have a clear frame of reference for what types of plans will work best for you. And to help you kick-start your search, we’ll review the eight highest-rated California Medicare Part D plans. Using the CMS star rating system, these insurance plans have been evaluated and ranked based on monthly premiums, cost-sharing factors like deductibles, co-payments and coinsurance, customer service, and more.

#1 Blue Shield Rx Enhanced S2468-004 (PDP)

    • Monthly Premium: $134
    • Deductible: $0
    • Rating: 4/5

Although this plan’s monthly premium is on the higher side, the $0 deductible makes it a great option for those who frequently take prescription medications. During your initial coverage phase, Tier 1 generic drugs cost a $2–$4 co-pay and Tier 2 generic drugs are a $7–$14 co-pay

Preferred brand-name drugs in Tier 3 cost $43–$86, depending on if you purchase a 30-day or 90-day quantity and whether you buy from a preferred pharmacy. Tier 4 and Tier 5 drugs have a 33 percent coinsurance.

Once you spend $4,130 in a year, you will enter the gap coverage phase that covers both generic and brand-name drugs with a 25 percent coinsurance. When your annual out-of-pocket costs reach $6,350, the plan’s catastrophic coverage phase kicks in and covers generic drugs with a $3.70 co-pay and brand-name drugs with a $9.20 co-pay.

#2 Blue Shield Rx Plus S2468-003 (PDP)

    • Monthly Premium: $59
    • Deductible: $445
    • Rating: 4/5

This prescription drug plan has a more affordable monthly premium with a moderate deductible. Tier 1 generic drugs have a $2–$4 co-pay, and Tier 2 generic drugs have a $6–$12 co-pay. Tier 4 drugs have a higher-than-average coinsurance rate of 41 percent, so if you take any medications that fall under this tier, that is something to think about. With this plan’s higher coinsurance rate, you are responsible for paying more of the prescription’s cost while your insurer pays for the remainder.

The gap coverage phase kicks in once you spend $4,130, where you’ll pay a 25 percent coinsurance for both generic and brand-name drugs. Once your annual out-of-pocket costs exceed $6,350, the catastrophic coverage phase kicks in. 

#3 WellCare Classic S4802-094 (PDP)

    • Monthly Premium: $30.10
    • Deductible: $445
    • Rating: 4/5

The low monthly premium and low co-pays for generic Tier 1 and Tier 2 drugs make this Part D plan as a great option. Tier 1 drugs are a $0–$6 co-pay, Tier 2 drugs are just $2–$18, and Tier 3 drugs are a $30–$117 co-pay. Tier 4 drugs have a 35 percent coinsurance, and Tier 5 drugs have a 25 percent coinsurance.  

#4 WellCare Value Script S4802-163 (PDP)

    • Monthly Premium: $17.20
    • Deductible: $445
    • Rating: 4/5

Of the top eight plans, this Medicare Part D plan has the second-lowest monthly premium. The plan’s annual deductible is also pretty affordable, at $445, and co-pays for Tier 1 generic drugs are inexpensive, with co-pays from $0–$15. 

While Tier 1 and Tier 2 generic drugs are affordable, Tier 4 drugs have a 47 to 50 percent coinsurance—which leaves you responsible to cover a large portion out of pocket. If you take any prescription medications that fall under this tier, it’s a good idea to do some rough calculations to see if this plan aligns with your estimated annual budget. Once you spend $4,130 on this plan, you enter the gap coverage phase, which has a better 25 percent coinsurance rate for generic and brand-name drugs. 

#5 WellCare Wellness Rx S4802-201 (PDP)

    • Monthly Premium: $15.20
    • Deductible: $445
    • Rating: 4/5

Of the top eight plans, this one has the lowest monthly premium. Paired with an affordable annual deductible and low drug costs for Tier 1 generic drugs, this Medicare Part D plan is an attractive option. While Tier 1 and Tier 2 co-pays are affordable, keep in mind that Tier 4 drugs have a 46 to 50 percent coinsurance rate, which is on the high side. Once you hit the plan’s gap coverage phase, which kicks in after you spend $4,130 in a given year, coinsurance rates drop to a better 25 percent for generic and brand-name drugs. 

#6 AARP MedicareRx Preferred S5820-031 (PDP)

    • Monthly Premium: $99.30
    • Deductible: $0
    • Rating: 3.5/5

Although this plan’s monthly premium is on the high side, the $0 deductible may make up for it, depending on the amount and type of prescription medications you take. The co-pays are $5–$45 for Tier 1 drugs, $10–$60 for Tier 2 drugs, and $45–$141 for Tier 3 drugs. Tier 4 drugs have a 40 to 45 percent coinsurance, and Tier 5 drugs have a 33 percent coinsurance

This plan’s gap coverage phase differs from other plans, with a $10–$60 co-pay for Tier 2 generic drugs. All other drugs have a 25 percent coinsurance in this phase

#7 AARP MedicareRx Saver Plus S5921-376 (PDP)

    • Monthly Premium: $29.20
    • Deductible: $445
    • Rating: 3.5/5

With an affordable monthly premium and co-pays that range from just $1 to $18 for Tier 1 generic drugs, this plan is a solid option for those who are looking for a plan to just cover the basics. The co-pays for Tier 2 drugs are $5–$30, and Tier 3 drugs are $25–$90. Coinsurance rates are reasonable, at 40 percent for Tier 4 drugs and 25 percent for Tier 5 specialty drugs. With this plan, you can also get 90-day qualities of prescription drugs delivered to you by mail.

#8 AARP MedicareRx Walgreens S5921-413 (PDP)

    • Monthly Premium: $41.60
    • Deductible: $445
    • Rating: 3.5/5

If you prefer to receive your prescriptions in the mail, this is another Medicare Part D plan that may appeal to you. For 90-day quantities, Tier 1 co-pays are $0–$45, Tier 2 co-pays are $18–$60, and Tier 3 co-pays are $120–$141. Tier 4 drugs have a 40 to 45 percent coinsurance, and Tier 5 drugs are covered at a 25 percent coinsurance—though you won’t be able to order Tier 5 drugs through the mail.

Ready to shop plans now? Use the Insurify Medicare comparison tool to find the right Medicare Part D plan for you. All you need is your ZIP code to compare plans instantly!

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How Much Do Medicare Prescription Drug Plans Cost in California?

If you’re looking for Part D coverage in California, you’ll find some affordable options. Although there aren’t any premium-free plans, you can find monthly premiums that range from as low as $7.20 up to $134.

Remember, though, that depending on your health circumstances, the plan with the lowest premium may not actually be the cheapest. If you take many prescription medications and choose a plan with a higher annual deductible and higher co-pays, you may end up spending more out of pocket than with a plan that has a slightly higher monthly premium but $0 deductible and low co-pays.

What Is Medicare Part D?

Medicare Part D is a prescription drug plan that is regulated by the Centers for Medicare & Medicaid Services and offered by private insurance companies. Anyone who is eligible for Medicare can enroll in a Medicare Part D plan, so long as their current health plans do not already cover prescription drugs. For example, if you have a Medicare Advantage plan that includes prescription drug coverage, you can’t add a Medicare Part D plan on top of that.

To be eligible for Medicare, you must be a U.S. citizen or permanent resident over the age of 65. There are special circumstances where individuals under 65 may be eligible for Medicare, such as being diagnosed with end-stage renal disease (ESRD) or having received Social Security Disability Insurance (SSDI) for 24 consecutive months. If you’re uncertain about your eligibility, you can visit Medicare.gov or call 1 (800) 633-4227. TTY users can contact 1 (877) 486-2048.

What Is the Enrollment Process for Medicare Part D?

All birthdays are special, but your 65th birthday is extra special because it marks your Medicare Initial Enrollment Period. Your Initial Enrollment Period begins three months before your 65th birthday and ends three months after. During this time, it’s imperative to enroll in Medicare benefits. If you do not enroll in Original Medicare and get prescription drug coverage during this window of time, you may face late enrollment fees for every month you are not enrolled. 

The late enrollment fee for Medicare Part D is equal to 1 percent of the national base premium, multiplied by the number of months you didn’t have Part D coverage. So let’s say you don’t have coverage for 12 months. The national base premium in 2021 is $33.06. Although the late enrollment fee is just $0.33 a month, that adds up to a fee of $4 added to your monthly premium after 12 months. In 24 months, that’s $8 added on top of your premium, and in 5 years, that is $20 on top of your premium.

This is why it’s recommended for Medicare beneficiaries to enroll in a basic Medicare Part D prescription drug plan from the start. If your needs change, you can always switch plans during the Open Enrollment Period, which happens every year from October 15 to December 7.

 

 

FAQ: California Medicare Part D Plans

How do I choose a Medicare Part D plan?

Choosing the best Medicare Part D plan for you all starts with getting clear on your needs and preferences. Consider factors like your monthly and annual budget, the amount and types of prescriptions you take, and your family medical history. This can help shape your priorities as you begin comparison shopping for Medicare Part D plans online.

Is Medicare Part D free?

No, Medicare Part D is not free, and in California, there aren't any premium-free Part D plans. If all the prescription drug plans you're finding seem out of budget, you may want to consider the Extra Help program, which provides financial assistance through a low-income subsidy. For more information on the Extra Help program, you can contact the Centers for Medicare & Medicaid Services.

Can I have Medicare Supplement Insurance (Medigap) and be enrolled in a Part D plan at the same time?

In most cases, yes. However, if your Medigap plan includes prescription drug coverage, then you cannot be enrolled in a Part D plan at the same time. 

Can I have Medicare Advantage (Medicare Part C) and a Medicare Part D plan at the same time?

Nope. Advantage plans are typically HMOs or PPOs that already come with Medicare prescription drug coverage. If you already have drug coverage with a health plan, you cannot simultaneously enroll in a stand-alone Medicare Part D plan. 

Conclusion: Compare Prescription Drug Plans Online to Save Time and Money

Finding the best health insurance and prescription drug coverage is now easier than ever to do on your own. The traditional route has always been to find and contact a licensed insurance agent for help, but now online resources and tools have enabled anyone to make a well-informed decision on their own. 

Save time and money with the Insurify Medicare comparison tool. All you need is your ZIP code to discover plans in your service area, compare your options, and find the Medicare Part D plan that’s right for you. Try it now!

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Updated April 29, 2021

Emily Vasquez is a content marketing writer based in Tampa, Florida. A graduate from the University of South Florida, Emily has worked as a copywriter, communications lead, and content strategist for high-growth start-ups and global brands and retailers. You can learn more at www.emvwrites.com