Prescription Drug Coverage
Medicare Part D
Beneficiaries can choose between plans that offer standalone prescription drug coverage or incorporate that coverage into a Medicare Advantage plan. We are happy to run through drug coverage and cost to find the best plan for you.
Do you need a drug plan when on Medicare?
When it comes to a prescription drug plan, you must have either Part A or Part B to join a standalone Part D plan with original Medicare. However, you must have both Part A and Part B to join a Medicare Advantage plan.
What does Medicare Part D offer?
Medicare Part D is a federal program that began in 2006. It provides Medicare beneficiaries with access to retail prescription drugs at an affordable copay. Prior to 2006, people on Medicare paid mostly out-of-pocket for their medications for over 40 years.
The benefit of having Part D coverage.
Medicare Part D is coverage for retail prescription drugs that you obtain from a retail pharmacy.
Here is important information you need to know about owning a prescription drug plan:
-
Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $505 in 2023. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
-
Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2023, the initial coverage cap is $4,660. After you and the insurance company together have paid this amount, then you enter the coverage gap.
-
The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 25% for generics. Your gap spending will continue until you have paid $7,400 out of your own pocket in 2023.
-
Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.
As an independent brokerage, we are here to help you find the right Medicare Part D coverage.