Prescription Drug Plans
What you need to know:
- There are two ways to get Medicare Part D prescription drug coverage. First is with a stand alone Part D plan offered by a private insurance company. Costs vary widely by plan and provider, each plan has it is own drug list (formulary), may have network pharmacies and the costs per prescription may vary depending on the drug stage you are in.
- You may also get Prescription Drug coverage with a Medicare Advantage that includes prescription drug coverage. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
- Medicare drug coverage is optional and is offered to everyone with Medicare. You must have Medicare Part A and/or have Medicare Part B to join a separate Medicare Part D plan.
- In order to get a Part D plan, you must live in the service area. Whether it’s a Stand Alone Part D or Medicare Advantage plan that includes Part D, each plan may have a monthly premium, deductibles, copays for each tier and/or coinsurance. Some plans offer mail order service which may offer cost-savings for your prescriptions.
- Review your plan’s formulary to make sure your drugs are covered and the costs for each drug. Your total prescription drug costs may be impacted by the number of prescriptions you take, how often, whether you get them at in-network pharmacies, and which coverage stage you are in.
- All drugs are grouped by tiers within their formulary. For example, your drugs may be Tier 1, Tier 2, Tier 3, Tier 4 or Tier 5. In general, lower tier drugs cost less than higher tiers. Each plan may require Step Therapy in order to save you money. Your plan may require you try one or more lower cost drugs before they will cover a brand name drug. Some drugs have quantity limits and also require prior authorization.
- There are 4 stages to each drug plan and they start over on January 1 each year. You may not go through each stage. The 4 stages are the Annual Deductible stage, Initial Coverage Stage, Coverage Gap (Donut Hole) Stage and Catastrophic Stage. Medicare may change the limits to enter and exit the coverage gap, as well as what counts toward reaching the limits each year.
- Although you are not required to enroll into a prescription drug plan, Medicare may charge a penalty of 1% of the average monthly Part D premium per month you delay enrollment. You have exactly 63 days to get Part D coverage without penalty.
Let's work together
Having a local professional agent who knows you by name and understands your circumstances can advise you through your entire Medicare journey, and updating you on plan changes that could affect your coverage is invaluable. So, let’s work together and find the best plan for you.