Basics of Part D Drug Plans
- Medicare Part D is prescription drug coverage.
- It is an optional benefit offered to everyone who has Medicare to help pay for prescriptions drugs.
- It is offered by private insurance companies.
- Part D plans have 5 payment stages (Annual Deductible / Initial Coverage / Coverage Gap (aka 'the donut hole' /Catastrophic Coverage)
- If you decide NOT to get Medicare Part D when you're first eligible, you'll likely pay a late enrollment penalty.
- However, there is no late enrollment penalty if one of these situations apply:
- You have other credible prescription coverage through your employer, union, TRICARE, the VA benefts or private ACA healthcare plan.
- You qualify and are receiving Extra Help through your state
Two Ways To Get Prescription Drug Coverage:
- Through a "Stand Alone" Part D plan .
2. Through Medicare Advantage Plans (Part C)
What Medicare Part D Plans Cover:
- Standardized -Each plan must give at least a standard level of coverage set by Medicare.
- Formulary -Each private insurance companies plan has its own drug list called a formulary
- Tiers -Most plans use tiered formularies to group covered drug according to cost.
- Drug costs usually rise in cost as the Tier Number increases.
- (Tier 1- Preferred generic drugs $ / Tier 2- Generic drugs $$ / Tier 3- Preferred Brand Name Drugs $$$ / Tier 4 - Non-Preferred Drugs $$$$ / Tier 5- Specialty Drugs $$$$$ )
- Quality limits -Quality limits may be set by the plan or by Medicare. Quality limits are in place to ensure safe and effective use of the drug.
- Star Ratings -Medicare uses a 5-star rating system to measure how well plans sponsors perform in different categories. These ratings help consumers compare plans based on quality and performance, with 1 star being the lowest score and 5 the highest.
Protect your health and review your Medicare options.
Costs for Medicare drug coverage
- You'll make these payments throughout the year in a Medicare drug plan:
- Plan Premium - varies from plan to plan and insurance company sponsoring the plan
- Yearly deductible - although some plans waive deductibles on some or all of the plans different Tiers
- Co-payment or co-insurance -vary from plan to plan
- Cost in the coverage gap if you reach this stage - set by Medicare
- Late penalty fee if you enroll in Part D late
Your actual drug plan costs will vary depending on:
- The drugs you use
- The plan you choose
- Whether you go to a pharmacy in your plan's network
- Whether the drugs you use are on your plan's formulary
- Whether you get Extra Help paying your Medicare Part D costs
**Tip- Use the Medicare Plan Finder Tool or consult with an independent insurance agent who can help you "shop" plans in your county to find you a plan covering your prescriptions at the most reasonable annual out-of-pocket cost for you.