Medicare Prescription Drug Plans

Prescription Pills

Medicare Part D is also referred to as a prescription drug plan. Medicare Part D is designed to subsidize the cost of prescription medication. Medicare Part D Plans are designed for people who are enrolled in original Medicare Part A & B. Those people who have opted to enroll in a private plan, Medicare Part C (Medicare Advantage Plan), will get their prescription drugs covered under their Medicare Part C Plan.

How Much Does Medicare Part D Cost?

Medicare Part D Plans vary in price but start at $10.00 per month. If you have limited income and assets you may qualify for a subsidy.

• Drug Tier (i.e. generics, name brand, exclusivity)
• Location of your pharmacy (i.e. local pharmacy v. mail order)
• The amount of money the enrollee has paid out-of-pocket during the year (4 stages)

Part D 2020 Standard Benefits Plan:

Medicare Part D subsidizes enrollees’ cost of prescription medication based the amount of money the enrollee has paid out-of-pocket throughout the year. The out-of-pocket limits are calculated on an annual basis and reset each year.

• Deductible: Enrollees pay 100% of their prescription drug cost up to the first $435.00 for specialty medication. However, the deductible is usually waived for most generic and widely sold prescription drugs.
• Initial Coverage: After reaching your $435.00 deductible, you will pay 25% of your prescription drug cost until they reach $4,020.00. Their cost would be $896.25
• There is no longer a Coverage Gap: After spending of $4,020.00 by you, your plan and any other source (as we discussed in initial coverage limit) you will pay 25% of generic dug costs and 25% of brand name drug undiscounted costs.
• FYI: Any spending after the initial coverage limit during the so-called gap period, the drug manufacture pays 70% of the cost of the drug. 70% goes towards your out of pocket costs, even though you are not paying it.

How do I now if my drugs are covered by Medicare Part D?

All PDP plans have a formulary which will list all the drugs they cover and how much they pay towards the drug. All formulary’s must be approved by CMS.