Prescription Drug
(part D)
Prescription Drug (Part D) plans help cover your medication costs and can help protect you from unexpected prescription costs in the future.
What are Medicare Part D Prescription Drug Plans?
Medicare Part D Prescription Drug Plans are designed to help lower your prescription drug costs. These plans are offered by private insurance companies and cover a list of medications (called a formulary). When you're enrolled in a Prescription Drug plan, you will pay copayments and deductibles instead of retail prices for prescription medications.
Do I need a Medicare Part D Prescription Drug Plan?
When you enroll into Medicare, you will need to have creditable drug coverage or you will accrue a lifetime monthly penalty even if you are not currently taking prescription medications!
You may not need prescription drug coverage if:
-
You have other creditable prescription drug coverage that is as good as Medicare's (Important: Not all drug coverage is considered creditable!)
-
You are enrolled in a Medicare Advantage Plan that has prescription drug coverage (many include Part D).
-
You have other benefits such as Veterans' benefits
If you are enrolled in a Medigap plan, these do not include prescription drug coverage!
How do Medicare Part D Prescription Drug Plans Work?
Medicare Part D plans are provided by private insurance companies. Each plan has limits and conditions outlined in a document called the "Evidence of Coverage."
Drug plans only cover certain medications which are outlined on a list called a formulary. All Part D plans are required to cover a range of medications. Generally, Medicare Part D plans must cover at least two medications in each category and class to ensure that beneficiaries have adequate options. It is important to carefully review your current prescriptions against a plan's formulary (we specialize in medication reviews!).
Many plans organize the medications they cover in their formulary into "tiers." Each tier has different tiers and costs. Generally, your costs will be lower for medications in a lower tier. Here is an example of a Part D plan's tier (your plan may vary):
-
Tier 1 - Generic - lowest copayment
-
Tier 2 - Preferred, Brand Name - medium copayment
-
Tier 3 - Non-Preferred, Brand Name - higher copayment
-
Tier 4 - Specialty - highest copayment
How much do Part D plans cost?
Each plan varies in their costs based on the plan premium and the medications that you're prescribed.
Generally, you will have these costs:
-
Monthly Plan Premium - this is a fixed monthly cost for the plan regardless of which (if any) medications that you're prescribed.
-
Prescription Drug Costs - these are based on the prescription drugs that you take. These costs can vary widely depending on the types of medications and pharmacy you use. These costs can vary significantly across plans so it's important to review your options.
Contact Us
(833) 624-6811