If you have both Medicare and Medi-Cal, most of your prescription drugs are paid for by Medicare Part D, not Medi-Cal. In order to get your medications at the pharmacy, you must be enrolled in a Medicare prescription drug plan or a Medicare health plan that includes prescription drug coverage. There are many different plans. Each plan has its own list of covered drugs, costs, and rules. You should choose a plan that covers all or most of your drugs. If you do not choose a plan, Medicare will assign you to a plan which may not meet your needs. Your Medicare drug plan sends you a membership card which you should present at the pharmacy when picking up your prescriptions.

Because you have both Medicare and Medi-Cal, you are eligible for “extra help” with your prescription drug costs. There a certain drug plans called “benchmark” plans which are designed for people who are eligible for this help. These plans have no monthly premium, deductible, or gap in coverage. You are responsible for a co-payment of no more than $1.10 to $6.00 for each prescription. You can join a plan that offers better coverage, but you will have to pay more.

Medi-Cal does not cover co-payments for Medicare prescription drugs. However, Medi-Cal will pay for some drugs that Medicare does not cover. These include sleeping pills, anxiety medication, drugs for weight loss or weight gain, and certain vitamins. Medi-Cal may also cover some over the counter medications, like cough or cold medicine. You need a doctor’s prescription for Medi-Cal to cover these drugs.

For more information on Extra Help for Part D costs you can read the California Health Advocates Fact Sheet Low Income Assistance: Extra Help for Part D Costs.
For more information on how Medicare and Medi-Cal work together you can read the California Health Advocates Fact Sheet Low Income Assistance Medi-Cal (for people with Medicare).