Choosing a Medicare Part D Prescription Plan
Finding the right prescription coverage can be a daunting process. Depending on where you live, there can be over a few dozen choices. In most states, there are over 20 stand-alone Part D drug plans to choose from various insurance carriers.
Medicare Supplemental plans cover some or all costs not covered by Parts A (hospital) and Part B (doctor/outpatient). A standalone Part D prescription plan is required to cover Medications.
Many Medicare Advantage Plans have Part D prescription plans bundled into a single plan. These plans are usually labeled MAPD (for Medicare Advantage + Prescription Drug).
How do I choose a Part D plan?
When choosing a Part D plan, you will want to make sure the following:
Your medications are covered by the plan formulary(different plans can have different formularies and with part D plans, it usually not the more expensive the better, it always come down the plan’s exact coverage for your medications)
The total annual cost(premium/deductible/copay) are acceptable to you and make sure you are getting the best deal when compared with other options on the market
You can get your medications from a pharmacy that is accepted by the plan
Our team can help you with finding the overall cheapest option based on your specific medications.
What if I don’t take any Medications?
It’s still recommended to enroll in a Part D plan so you have prescription coverage.
If you do not have prescription coverage and you do not sign up for Part D, you may be penalized 1% of the national average cost of a Part D plan ($34.70 in 2024) for every month you were not covered. This is added onto your premium each month permanently when you do enroll (Source: medicare.gov)
I have coverage through an employer drug plan or Tricare, do I still need a Part D plan?
You’ll need to check with your human resources department to see if your current drug coverage is considered “credible coverage.” If yes, then you will not be penalized for not signing up for a Part D plan. For most TRICARE enrollees, TRICARE provides prescription coverage so you may not need to enroll in a part D plan.
However, it would be wise to compare benefits to see if you would get better coverage under a standalone Part D plan.
What if I’m unhappy with the plan that I chose?
You can switch part D plans every year between October 15 – December 7 for coverage starting the following January. This is called the Medicare annual election period or open enrollment period. There are also other special enrollment periods that will allow you to switch to a different plan during the year, such as certain life changing events like moving, lost Medicaid, natural disaster, etc. We always recommend checking with our team to see if you may qualify for any of these life changing events.
What’s the Medicare part D coverage cap in 2025?
Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. If your out-of-pocket spending on covered drugs reaches $2,000 (including certain payments made on your behalf, like through the Extra Help program), you’ll automatically get “catastrophic coverage.” That means you won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year. (Source: medicare.gov)
Recap
When you enroll in a Medicare prescription plan, make sure to check the following:
1. All your medications are covered in the formulary (formularies can be different even if two plans are from the same company)
2. Your co-pays and deductibles are acceptable to you financially
3. You will have access to a pharmacy that’s convenient for you
Remember, once you enroll in a Part D plan, you’re not locked in for life. You can choose to switch at least every single year. Our team is here to compare all the different options on the market and analyze your medications to see which prescription drug plan will provide you with the appropriate coverage and give you the best deal on your medication copays.