Medicare Part D in California

Medicare Part D has had a profound impact on Californians. More than 4.2 million elderly and disabled Medicare beneficiaries in California are affected, the largest Medicare population of any state, as well as the most diverse (12 percent Hispanic/Latino, 11 percent Asian/Pacific Islander, 5 percent African American). One-third of California’s Medicare beneficiaries are in Medicare Advantage plans (e.g., HMOs).

Californians have a dizzying array of Medicare Part D plan choices. There are 47 stand-alone prescription drug plans (PDP) to choose from, along with a number of Medicare Advantage Plans with prescription drug coverage (MA-PD) (the number of MA-PDs varies by county from 2 to 30). Thus, for example, individuals residing in Los Angeles, the county with the greatest number of plans, have 77 plans to choose from.

Dual Eligibles in California

California is also home to the largest number of dually eligible beneficiaries (individuals on both Medicare and Medi-Cal). Approximately one million seniors and individuals with disabilities in California are dual eligibles. This group is extremely diverse (22% Hispanic/Latino; 20 percent Asian/Pacific Islander; 10 percent African American); one in five is limited English proficient (LEP). Over 60,000 dual eligibles are in long term care settings. Approximately ten thousand individuals become newly eligible each month in California.

Prior to January 1, 2006, this group received fairly comprehensive drug coverage through Medi-Cal. As of that date, comprehensive drug coverage through Medi-Cal ceased and dual eligibles were enrolled in private Medicare Part D plans (either through auto-enrollment through a PDP, enrollment in an MA-PD program, or by choosing a plan). In California, there are 9 plans used for auto-assignment of dual eligibles receiving the Low-Income Subsidy. The majority of dual eligibles will receive prescription drug coverage from one of these 9 plans; although approximately 87,000 dual eligibles have been placed into a Medicare Advantage plan with an associated drug plan (MA-PD).

Because the transition to Medicare Part D for this population has been far from smooth, California’s legislature enacted a bill (California Welfare and Institutions Code Section 14133.23) to provide for emergency back-up coverage by the California Department of Health Services for the first several months of 2006. More information about this coverage is found in the alerts and news below.