Prescription Drug Coverage
If you or a loved one are nearing retirement age, it’s time to start thinking about medication insurance. Medicare Part D covers your prescriptions and is a federal program administered through private insurance companies. Keep in mind that Part D is insurance not just for your medications today – it also insures you for any new medications your doctors prescribe in the future. Many people eventually need prescription drugs, whether for a minor illness or a chronic condition, and Part D protects against unexpected costs.
Everyone with Medicare Part A or Part B is eligible to enroll, but it’s best to do so when you first turn 65, during the initial enrollment period. There is generally a late penalty for waiting to enroll and it can be as high as 10% for each year you put it off. You move through 4 stages of coverage as your prescription spending increases:
- Until you meet your annual deductible you pay the network discounted price for your meds. The amount of the deductible differs by company.
- Once you’ve met your deductible, your meds are covered by initial coverage in which you pay a copay, set by the drug plan you choose. You’re eligible for initial coverage until you’ve spent a combined total of $3,820 in 2019.
- At this point, you enter the donut hole. Here, coverage is more limited but you generally still have discounts for your medications. In 2019, you’ll pay 25% of your brand name meds and 37% of generics. This period continues until your total out of pocket drug costs exceed $5,100 in 2019.
- Finally, you enter catastrophic coverage in which your plan pays 95% of the costs of your prescriptions for the rest of the year. This helps to limit spending, especially on expensive medications.
When making your annual decision, you have the choice between many, sometimes dozens, of Medicare Part D plans. Of these, there isn’t always a right and wrong answer as to which one is best. There is no best plan and no worst plan, which can make things complicated. Our pharmacists help you evaluate the best Medicare Part D option to fit your prescriptions. Already have Part D, but thinking of making changes? No problem! We help with that too, and consultations are always free. The open enrollment period is October 15th – November 7th.
Enrollees who rely on us to compare their options save an average of $1,150 each year.