Prescription Drug Coverage
How Do I Enroll?
To get the PDP you want, either:
Good-bye Donut Hole
Is This the Right Plan for Me?
The Plan’s Formulary
A formulary is simply the list of prescription drugs covered under the plan, and each Medicare Prescription Drug Plan has its own one. If you can’t find the medication or medications you need on a plan’s formulary, we suggest you talk with your physician about alternative medications.
The Plan’s Network
It’s fairly standard for a plan to come with an “in-network” list of approved pharmacies. These are selected on the basis of lowest prescription drug prices. The risk you take going out of network is that you may end up paying more for your medications.
The Mail Order Option
There are plans which offer you better prices for drugs you get via mail order pharmacies. Since your plan may require a three-month minimum per order, it may be smart to ask your doctor if the mail order option makes sense given the medications you need.
The Detail on Covered Drugs
Part D plans generally sort prescription drugs by tier, and each tier has a different cost. The rule of thumb is, the lower the tier, the lower the drug cost; and the higher the tier, the higher the drug cost.
It’s possible for your plan’s formulary to change during the year. Your plan is required to give you two options should your list of medications be affected by this change:
Here’s a breakdown of the different tiers and associated costs. Remember that you should inquire about how your plan structures its tiers since each plan has its own tier system.
Lower co-payment, offering most generic prescription drugs.
Medium co-payment, offering preferred brand-name prescription drugs.
Higher co-payment, offering non-preferred brand name prescription drugs.
Highest co-payment or co-insurance, offering specialized, high-cost prescription drugs.
Although Part D drug plans are entitled to provide their own formularies from the comprehensive list of covered prescription medications, they are barred from creating formularies which exclude specific drugs in order to discriminate against certain enrollees.
Should your plan not have a drug that you require, it’s in your rights to ask for a written explanation, and request an exception.
Formularies have to include at least two prescription drugs in each category, covering the bulk of medications in the six protected classes of prescription drugs:
Additionally, all available vaccines have to be covered by Part D when they are needed to prevent illness, except for vaccines covered under Medicare Part B.
For more detailed information regarding Medicare Part D visit medicare.gov.
Still confused? Call us!
Table of Contents
No, some MA plans do not include drug coverage although most do.
Yes. You need to enroll in Part D during your Initial Enrollment Period.
They vary from plan to plan, but the most you’ll pay in 2023 is $505.
The coverage gap will be closed by law by the end of 2019, but you should learn about how it works now.
- Best overall Medicare supplement for new enrollees: Plan G
- Best overall Medicare supplement before 2020: Plan F
- Best low cost Medicare supplement: Plan K
- Best alternative to Plan G Medicare supplement: Plan N
Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.
Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.
The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.
Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.
For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.
It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.
Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.
Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.
The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.
The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.
Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.
It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.
Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.