Getting Prescription Drug Coverage

by | New to Medicare, See All, Turning 65 This Year

If you have Medicare, prescription drug coverage is an optional benefit. But be aware – if you don’t get a Medicare drug plan when you’re first eligible, you may have to pay a late enrollment penalty to join later on.

Part D drug coverage is only available from private companies contracted with Medicare. You usually choose Part D drug coverage in one of two ways:

  1. A separate “stand alone” drug plan. These plans add drug coverage to Original Medicare.  A Stand alone drug plan is not a Medicare Supplement. 
  2. Or you can get your part D drug coverage as part of a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. You must have Part A and Part B to join a Medicare Advantage Plan.

Consider all your drug coverage choices

Before you decide on a plan, you need to know how the Medicare prescription drug plan will work IF you have another drug plan. For example, you may have drug coverage from an employer, TRICARE, or the Department of Veterans Affairs (VA).  Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because you enrolled in a Medicare drug plan.  So consider all your options. Call us BEFORE you make any changes to your current coverage.

We like to share this as Drug Plan Stages. Take a look at where you might be in these scenarios;

Stage one – Deductible Stage:

The 2023 Drug deductible is up to $505.00 per year. Your medications are covered after you spend $505 out-of-pocket.  NOTE:  many drug plans waive the deductible for lower cost drugs.  This means you will not pay the deductible.

Stage two – Initial Coverage Stage:

The maximum drug benefit for 2023 is $4,660.00 for the entire year. What if you have a single drug that costs $300 per month? That will result in your using 75% of your drug benefit on one Medication! Once you have exceeded the maximum drug benefit, you will be in the gap or donut hole.

Stage three – the Donut Hole:

In this stage for 2023, you will pay 25% of brand name drugs and 25% of the generic drug cost.

Stage four – Catastrophic Stage:

Example:  2023 – Once you reach this stage, about 95% of your drug cost is covered by the plan, but it will cost you almost $5,000.00 to get to this stage. You join a Medicare Prescription Drug Plan (Part D)

So, where do I start on choosing Medicare drug coverage?

The best way is to choose a Medicare drug plan that works for you is to consider your priorities. Find out your priorities using this list of situations that may apply to you:

  1. take specific drugs,
  2. want protection from high prescription drug costs,
  3. need to balance drug expenses throughout the year,
  4. take a lot of generic prescriptions and want to avoid future penalties,
  5. like the extra benefits and lower costs by combining health care and prescription drug coverage in one plan, or
  6. are willing to pick a drug plan with restrictions on what doctors, hospitals, and other health care providers you can use.

Remember drug plans are not the same. You need an agent that will run your drug list based on specific medications you are taking, and we can help with that. Give us a call. 833-777-GARY (4279)