Medicare Part D and other drug coverage
Medicare prescription drug coverage, through a stand-alone Part D plan or a Medicare Advantage plan, and how it works with Extra Help or other creditable drug coverage such as employer, retiree, COBRA, VA or TRICARE. The plan choice is yours; HICAP gives free, unbiased help.
A directory listing, not an eligibility decision.
UniHealth can identify a possible match, but the responsible program makes the final decision.
What to know
- Why it may fit
- Your current coverage, doctors, or medicines may affect whether this option fits.
- What to do next
- Medicare drug coverage. You get it from a drug plan or from a Medicare Advantage plan with drug coverage. The plan choice is yours.
- Who runs it
- CMS / contracted plans
What the program may consider
- Medicare eligibility
- Part D plan serves California
- Medicines, dose, formulary rules and pharmacy pricing
- VA, TRICARE, employer, retiree, COBRA, or other creditable drug coverage
- Permitted Part D enrollment period or Extra Help SEP
How to get it
Medicare drug coverage. You get it from a drug plan or from a Medicare Advantage plan with drug coverage. The plan choice is yours.
Before you start
- You need this first Original Medicare. You need Medicare Part A or Part B.
- Having this helps Extra Help with Medicare drug costs. With Medi-Cal, or with Extra Help that lowers drug costs, you can change drug plans once a month.
How to apply
Request to join a Medicare health or drug plan
Only the person or their legal representative can ask to join. The plan's own phone line and website also take requests.
The same application can also ask for Medicare Advantage, Chronic Condition Special Needs Plan (C-SNP), Dual Eligible Special Needs Plan (D-SNP / Medi-Medi) and Institutional Special Needs Plan (I-SNP).
- OnlineMedicare.gov plan finderSee the plans in your area. You can also ask to join a plan there.
- Phone1-800-MEDICARE: 1-800-633-4227
- PhoneHICAP free Medicare counseling: 1-800-434-0222Free, unbiased help with Medicare choices.
- PhoneSourcewise information line: (408) 350-3200Weekdays, 8 a.m. to 5 p.m. Ask for the program you need.
- Online formSourcewise HICAP counseling requestAsk for yourself or for someone else.
- In personHICAP counseling sitesSenior centers, libraries and community centers. Call the site or book online.
Getting help
You start this yourself
Only you can choose and join a plan. A guardian, or someone with legal power to make your health decisions, may join for you. Others can help, but the choice and the request must be yours. HICAP gives free, unbiased help.
Only you, or someone with legal authority for you, can sign.
What happens after you apply
Join when you first get Medicare, or October 15 to December 7. Losing other drug coverage gives you 2 full months to join.
YouA helper can help with this
Medicare puts you in a drug plan. You can switch to another plan once a month.
If you have Medi-Cal or Extra Help and no drug plan
Medicare
You choose a plan and ask to join. Use Medicare.gov, call 1-800-MEDICARE, or contact the plan.
YouOnly you can do this
The plan checks your Medicare and your sign-up window.
Your health plan
The plan mails you a letter. It confirms you are in and says when coverage starts.
Your health planWithin 10 days after Medicare accepts the request.
The plan mails your member card. Show it when you get care, and keep your Medicare card too.
Your health planOnly you can do this
Coverage starts the first day of the next month. If you joined October 15 to December 7, it starts January 1.
Your health plan
What only you can do
- Choose a drug plan yourself, or through your legal representative. HICAP can explain your options for free.
- Sign the plan form, or agree by phone or online.
- Avoid a gap of 63 days or more without drug coverage as good as Medicare's. Otherwise a late fee can last as long as you have drug coverage.
- How long it takes
- Coverage starts the first of the month after the plan gets your request. Changes made October 15 to December 7 start January 1.
- You are enrolled when
- You are enrolled when the plan's letter confirms your start date and you have its member card.
- To keep it
- Coverage continues each year unless you change it. If you have Extra Help through Medi-Cal, keep your Medi-Cal active.
Can’t be combined with
- Medicare Advantage. Joining a separate drug plan usually ends a Medicare Advantage plan. You go back to Original Medicare.
- Program of All-Inclusive Care for the Elderly (PACE). Joining PACE ends a separate Medicare drug plan. PACE covers your drugs.
Coming changes
- Starting January 1, 2027: Starting January 1, 2027, the most you pay each year for covered drugs rises from $2,100 to $2,400. The highest deductible a drug plan can have rises from $615 to $700.
- Starting January 4, 2027: Some people who are not citizens lose Medicare on January 4, 2027. Citizens and green card holders keep it. So do Cuban or Haitian entrants and some Pacific island residents. Social Security writes first to people who will lose it. Their plan ends too.
Choosing a Medicare plan is your decision. UniHealth does not choose, recommend, or enroll anyone in Medicare plans. For free, unbiased help, call HICAP at 1-800-434-0222.