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Medicare Prescription Drug Plans

Medicare Part A and Part B does not provide prescription drug coverage at the pharmacy. It only includes coverage for prescription drugs while hospitalized. If you regularly take prescription medication, the out-of-pocket costs could be substantial if you only have Medicare Part A and Part B. Fortunately, private insurance carriers offer Medicare Part D plans to cover some costs of prescription drugs.

Enrollment in Medicare Part D is similar to Medicare Advantage. You can enroll during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday (starting with 3 months before you turn 65, continuing the month that you turn 65, and ending 3 months after you turn 65). Those who are under 65 may be eligible to enroll in a Medicare Part D plan if they are disabled. You may also enroll in a Medicare Part D plan during the Open Enrollment Period. Open Enrollment begins on October 15 and ends on December 7 in 2017. If you miss Open Enrollment, you could still get a plan if you qualify for Special Enrollment. You may qualify for Special Enrollment if you experience certain life changes, such as moving to a new state or losing health coverage.

Medicare Part D plans can be purchased as either (1) standalone coverage, which is in addition to Medicare Part A and Part B or a Medigap plan, or (2) as part of a Medicare Advantage plan.

Medicare Part D: Coverage and Costs

Though Medicare Part D plans are provided by private carriers, they are still regulated by the government. All Part D plan must cover the following:

  • At least two different drugs from all categories of medications.
  • At the least the majority of drugs from the following categories:
    • Cancer
    • Immunosuppressants
    • Anti-depressants/anti-psychotics
    • HIV/AIDS

Medicare Part D plans generally pay around 60% of brand-name and 49% of generic prescription drug costs. Once the plan pays for a total of $3,700 in costs for the year, you are in the so-called “donut hole.” During the “donut hole,” the coverage drops to your insurance paying only 50% for brand-name and 14% for generics. However, once you have spent a total of $4,950 out-of-pocket for the year, catastrophic coverage begins.

Under catastrophic coverage, you will pay a small copayment, and the plan will pay for nearly all of your prescription drug costs.

When shopping for a plan, it is best to check if the prescription drugs that you currently take - or those that you think you might need at one point - are covered as part of the plan. Each plan has a different list of covered drugs. This is known as the plan’s “formulary.” If a drug is not on the list, then you generally have to pay the full price for that drug.

There are two types of Medicare Prescription Drug Plans:

Medicare Part D Plan Type:

Description:

Medicare Advantage Prescription Drug Plans (MAPDs)

This is the type of drug plan you will get if you plan on getting a Medicare Advantage Plan.
Most comprehensive Medicare Advantage Plans are already packaged with this drug plan, but be sure to verify before enrolling.

Prescription Drug Plans (SPDPs)

This is the type of drug plan you can get if you have a Medicare Supplement plan or just Medicare Part A and Part B.
It is a stand-alone plan and must be purchased separately from other plans.
You cannot purchase this type of plan if you have Medicare Advantage.

The premiums for Part D Medicare plans can vary from carrier to carrier and from state to state. Monthly premiums for MAPDPs start around $5***, while SPDPs start around $11.40*** in 2017.

For those currently on Medicaid or Supplemental Security Income (SSI), you may qualify for the Medicare Extra Help Program. The Medicare Extra Help Program is a government subsidy program that reduces your Part D premiums and deductibles. It can also remove the “donut hole”, giving you coverage with no limits.

You may also qualify for partial Medicare Extra Help if your monthly income is no more than $1,507 for individuals or $2,030 for married couples, and your “countable resources” (stocks, bonds, money in a savings or checking account) do not exceed $13,820 (individuals) or $27,600 (married couples). Please check with the government or visit Medicare.gov to apply and learn more.

Quick Facts:

  • You can buy a Medicare Part D plan separately or as part of a Medicare Advantage plan.
  • Rates can vary across carriers and the state you live in.
  • Plans by law are standardized to cover the most common medications. However, when shopping for a plan, it is important to check the plan’s formulary, or the exact medications the plan covers.
  • Medicare Part D plans can be purchased during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday – 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65 - or during the Open Enrollment Period, which begins on October 15 and ends on December 7. You may still be able to enroll in a plan if you miss these enrollment windows if you experience certain life changes, such as moving or losing health coverage.
  • Those who are under 65 may be eligible to enroll if they are disabled.

Please submit your zip code to start comparing Medicare Part D plans. You can also call (855) 902-9647 to speak with a licensed sales agent.

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