Prescription Drug Coverage Explained.
Medicare Part D helps cover outpatient prescription medications. Coverage may be included in a Medicare Advantage plan or purchased as a stand-alone prescription drug plan when you have Original Medicare.
Drug Coverage Varies From Plan To Plan.
Each Part D plan has its own list of covered medications, called a formulary, along with its own pharmacy network and cost-sharing structure.
Formulary
Each plan maintains a list of covered medications. Your prescriptions should be checked before choosing or renewing a plan.
Drug Tiers
Covered drugs are commonly grouped into tiers that can affect your copay or coinsurance.
Pharmacy Network
Using a preferred or in-network pharmacy can sometimes reduce what you pay for prescriptions.
The Cheapest Premium Is Not Always The Lowest-Cost Plan.
A plan with a low monthly premium can still cost more overall if your medications are on higher tiers or your pharmacy is not preferred by the plan.
- Your current prescriptions
- Medication dosages
- Plan formulary coverage
- Drug tiers
- Preferred pharmacies
- Mail-order options
- Monthly premiums
- Estimated annual drug costs
Prescription Coverage Can Be Built Into Your Medicare Strategy.
Stand-Alone Part D Plan
If you have Original Medicare, you can generally enroll in a stand-alone Medicare prescription drug plan to add outpatient drug coverage.
Medicare Advantage With Drug Coverage
Many Medicare Advantage plans include Medicare Part D prescription drug coverage as part of the same plan.
Your Part D Costs Can Change Even If Your Prescriptions Do Not.
Prescription drug plans can change their premiums, formularies, pharmacy networks and cost sharing from year to year.
Formulary Changes
A medication may move to a different tier, require additional plan rules or no longer be covered.
Pharmacy Changes
Your preferred pharmacy may have different pricing or network status the following year.
Premium & Cost Changes
Monthly premiums and prescription copays or coinsurance can change annually.
Going Without Creditable Drug Coverage Can Have Consequences.
If you go 63 consecutive days or more without Medicare Part D or other creditable prescription drug coverage after you are eligible to enroll, you may have to pay a Part D late enrollment penalty if you enroll later.
We Can Help Compare Plans Using Your Actual Prescriptions.
Parker County Medicare Advisors can help you review prescription drug options based on the medications you take and the pharmacies you prefer to use.
Looking at your actual prescriptions can provide a more useful comparison than choosing a plan based only on its monthly premium.
Want Help Comparing Medicare Part D Plans?
Request a no-cost consultation and we can review your prescriptions and coverage options together.