Medicare Part D is a federal prescription drug coverage program offered by private insurance companies. Prescription drug coverage can be purchased one of two ways:
- Bundled with medical. Most Medicare Advantage plans cover both Part C (medical) and Part D (drug) plans, eliminating the need to manage more than one insurance plan. These plans are called Medicare Advantage with Prescription Drug (MAPD) plans.
- Stand-alone plans. If you are not in a Medicare Advantage plan that “bundles” medical and drug coverage you can purchase a stand-alone Part D or drug-only plan. These are for individuals who otherwise do not have Part D coverage, either because they carry Original Medicare (Parts A and B), a Medigap plan (also called a Medicare Supplement plan, which does not include Part D benefits), or a Medicare Advantage (Part C) plan that does not offer prescription drug benefits.
What is covered by Part D depends on the plan; each plan offers a list of prescription drugs (called a formulary). The formulary will tell you what drugs are covered. It will also tell you the drug tier, which helps you determine what the drug will cost.
Changes to Medicare Part D for 2019
While the costs of many things are rising, this year, the federal government has instituted policies to help Medicare beneficiaries save money.
- The so-called “donut hole” — a temporary limit on covered prescription drug costs that has been in the process of slowly phasing out over the past few years — will only affect generic drugs in 2019.
- Certain low-cost generic drugs can now be substituted onto plan formularies any time, passing the savings to beneficiaries more quickly.
- Some innovative medications known as “biosimilars” have seen a widespread reduction in price.
- Competition among pharmacies has been incentivized, increasing access for beneficiaries.
Overall Costs for Part D
Despite these savings, understanding Part D costs can feel overwhelming — and it always helps to talk to an expert. But here are a few basic facts to get you started:
- You may be responsible for a deductible. Some Part D plans require you to satisfy an annual deductible of up to $415 out of pocket before coverage kicks in. MAPD plans from Independence Blue Cross (Independence) do not have a prescription drug deductible, so your medications can be covered right away.
- You’ll probably pay copays or coinsurances. Most plans assign copays or coinsurance for drugs by sorting the medications into different tiers, from least expensive to most expensive, but there are some ways to save money. Costs can vary based on whether prescriptions are filled at in-network pharmacies, and some plans, including MAPD plans from Independence, offer special discounts for using preferred pharmacies. Your carrier may also offer discounts for buying three-month supplies of your medications at a time or buying through an approved mail-order program; both benefits are available to Independence MAPD members.
- You may move through different coverage stages. If you, like many Americans, take more than one prescription medication, you may move through some different coverage stages with your Part D coverage: the Initial Coverage stage, the Coverage Gap stage, and the Catastrophic Coverage stage. During each stage you are responsible for a different percentage of your drug costs. A representative of the plan can help you understand what your costs will be during each stage, and you may be able to get assistance with affording your medications through a Medicare cost-saving program or directly from their manufacturers.
Questions about managing your prescription drugs? Help is available. Contact a licensed agent if you have questions.
Website last updated: 1/9/2019