Catalina Island Health and Leo’s Catalina Drugstore know that navigating Medicare can be confusing. To help sort it out for the community, they are specifically sharing information about Medicare Drug Coverage (Part D), ways to lower your drug costs, and the Medicare Prescription Payment Plan.
If you are on Medicare, your total costs for drug coverage are dependent upon which plan you choose. You will always have to pay your premium. That payment varies due to the plan you choose and your income. Depending on that income, you may also have to pay an additional amount. Currently, that added amount could be between $13.70 and $85.80 per month.
If you are about to enroll in Medicare: It is highly recommended that you get a drug plan with a low monthly premium from the start. Even if you aren’t taking many drugs now or your current out-of-pocket drug costs are low. This will help you avoid the late enrollment penalty. That penalty can be considerable as it is not a one-time fee. You will pay that fee on top of your premium and typically, you be paying the penalty fee for as long as you have Medicare drug coverage. Also, that penalty may go up each year.
However, if you have what Medicare considers creditable prescription drug coverage – from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance – you may not need the drug plan.
If you are already on Medicare and do not have a drug plan or creditable prescription drug coverage, you will face the late enrollment penalty if/when you decide to add a drug plan.
In general, Medicare drug plans and Medicare Advantage Plans with drug coverage have three stages:
- Deductible stage: If your Medicare plan has a deductible, you pay all out-of-pocket costs until you reach the full deductible just like any other insurance plan. In 2025, no Medicare drug plan deductible can be more than $590. Some Medicare drug plans don’t have a deductible.
- Initial coverage stage: After you reach your deductible (if your plan has one), you’ll pay 25% of the cost as coinsurance for generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,000 in 2025. Then, you will automatically get “catastrophic coverage.”
- Catastrophic coverage stage: You will not have to pay out-of-pocket for covered Part D drugs for the rest of the year.
You’ll want to pay attention to your Explanation of Benefits (EOB) that are sent a month after the pharmacy bills your Medicare drug plan. That will show you who has paid what and will update you on what coverage stage you are in.
There are programs that can lower your drug costs, if you qualify.
- Medicaid (in CA it is Medi-Cal): A joint federal and state program that helps cover medical costs for some people with limited income and resources. Call the Medi-Cal Helpline at 800-541-5555 or 916-636-1980 to see if you are eligible.
- Extra Help: A Medicare program that helps pay your drug costs. You automatically qualify for Extra Help if you qualify for Medi-Cal, one of the Medicare Savings programs, or Supplemental Security Income (SSI) benefits from Social Security. If you don’t automatically qualify, you can apply for it.
- Medicare’s Limited Income Newly Eligible Transition (LI NET): A Medicare program that provides temporary, immediate prescription drug coverage at the pharmacy counter to people with Medicare. This is available to people who qualify for Extra Help but aren’t enrolled in a Medicare drug plan yet. LI NET covers all Part D covered drugs.
You can apply for Extra Help via the Social Security Administration website: ssa.gov
- State Pharmaceutical Assistance Programs (SPAP): Through this program, California (or your state) provides coverage to pay your drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Eligibility depends on each program’s specific rules. Visit the California Department of Public Health website to learn more: cdph.ca.gov
- Pharmaceutical Assistance Programs/Patient Assistance Programs (PAPs): Some pharmaceutical companies offer programs to help pay for medications for people enrolled in Medicare drug coverage (Part D). Each company has different eligibility requirements to participate.
You’ll have to contact each company directly to see if you’re eligible. Visit Medicare.gov/plan-compare/#/pharmaceutical-assistance-program to search for programs related to the drugs you take.
A new payment option to help manage your out-of-pocket costs for drugs covered by your plan is the Medicare Prescription Payment Plan. This works with your current Medicare drug coverage plan or Medicare Advantage Plan with drug coverage and allows you to spread the costs across the calendar year (January – December). There is no cost to participate in this plan.
If you choose this option, you will continue to pay your plan premium each month (if you have one) and you’ll get a bill from your health or drug plan to pay for your prescription drugs. You will not pay the pharmacy directly for the drugs.
It is worth noting that this payment plan may help to manage your monthly expenses, but it does not save you money or lower your drug costs.
The staff at Leo’s Catalina Drugstore and the CIH primary care clinic will always do their best to help answer questions and lead you to the proper resources. For specific questions or assistance, you can call the clinic at 310-510-0096 to make an appointment with CIH’s social worker, Jenea Woodyard.
About Catalina
Island Health
CI Health’s primary care physicians and family nurse practitioners provide the island community with a solid foundation of care. The medical clinic is located at 100 Falls Canyon Road, Avalon, CA, up the street from Avalon’s City Hall on the bottom level of the hospital. Its hours are 8 am to 5 pm, Monday through Friday. Visit CatalinaIslandHealth.org or call 310-510-0096 for more information or to make an appointment.
The emergency room is staffed 24/7 with a UC Irvine Emergency Medicine Physician and supported by the CI Health’s laboratory and diagnostic imaging departments to meet the acute medical needs of Catalina Island’s residents and visitors. With the use of patient satisfaction surveys, patients consistently rank CI Health’s emergency services as one of the best in the nation.
The hospital’s main number is 310-510-0700. For more information, visit CatalinaIslandHealth.org.
About Leo’s
Catalina Drugstore
Leo’s Catalina Drugstore has proudly served Catalina Island since 1959. As the island’s only pharmacy, Leo’s has highly trained pharmacy staff who provide patients with personalized and professional care. It’s gift shop offers a wide variety of sundries, toys and games, personal care items, gifts, souvenirs, and more.
