Medicare prescription drug plans, also known as Medicare Part D, provides coverage for your prescriptions. These may be purchased as a standalone plan or may be an additional benefit in some Medicare Advantage Plans.
Every Medicare Part D plan will have a formulary, also known as a list that describes the prescriptions the plan will cover. Medicare requires that Part D plans have to cover two drugs from each class. Part D plans must also cover all, if not most, of the prescription drugs in these specific classes:
Part D plans will also cover vaccines that are used to prevent disease or illness.
A Medicare Part D plan will not cover:
There are some significant changes to Medicare Part D plans for the upcoming 2025 plan year.
The first significant change is the elimination of the Coverage Gap phase often referred to as the “Donut Hole”.
The second significant change is the capping of out-of-pocket costs at $2000.
The third significant change is the creation of a Medicare prescription Payment Plan which may be useful for those that have high prescription costs especially earlier in the year before deductibles are met and before the out-of-pocket cost cap is reached.
Part D plans will also typically add the prescriptions they cover into a tier-system. The prescriptions in each tier will have a different cost, but those in a lower tier will cost less than those in a higher tier. An example of a tier-system would look something like this:
Once you have a prescription drug plan, you will have several rights that include:
Not affiliated with the U.S. government or federal Medicare program. I do not sell all carriers in the service area of Western New York. I do not offer every plan available in your area. Currently I represent 9 organizations which offer 112 products in Western New York. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information.
