The Medicare Drug Benefit: Changes in California for 2008

Avalere Health


Open enrollment for the Medicare Part D prescription drug benefit ran from November 15 through December 31, 2007, and provided an opportunity for Medicare beneficiaries to enroll or change plans.

This CHCF fact sheet, published in November 2008, highlights several important changes to the drug benefit and the options available to Medicare beneficiaries in California in 2008. It examines changes in the number of participating plans, benefits, premiums, and cost sharing.

Key findings include:

  • Medicare members in California — particularly those who wanted to receive their drug benefit through a Medicare Advantage health plan — had more plans to choose from in 2008.
  • Most beneficiaries enrolled in standalone drug plans would see a sharp rise in premiums if they chose to remain in their current plan, while most beneficiaries enrolled in the Medicare Advantage drug plan would see their premiums decrease or stay the same.
  • The average increase in PDP premiums for beneficiaries in California who remained in their existing plan was nearly twice the national average.
  • More plans would provide generic drug coverage within the Part D “doughnut hole” — the gap between the initial coverage limit and the threshold for catastrophic coverage. Brand-name drug coverage in the doughnut hole would be available only from a few Medicare Advantage plans.
  • As in 2007, most plans would not require a beneficiary to pay a deductible before receiving drug coverage.
  • California’s low-income Medicare population in need of plans with no premium would have fewer options, and a significant proportion would have to switch plans to receive their full federal subsidy and thus avoid paying higher premiums.

The complete fact sheet is available under Document Downloads.