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Providing Healthcare Solutions to Seniors

Prescription Drug Plans

What is Medicare Part D?

Medicare Part D is also called the Medicare prescription drug benefit.  You are entitled to this benefit if you have Part A and or B.  These Part D plans are offered through private insurance companies approved by Medicare.  The cost of your drug plan is dependent on your current medications.  

Things to consider:

  • If you do not join a Medicare drug plan when first eligible and you don’t have other creditable prescription drug coverage (such as a creditable employer sponsored plan) you may have to pay a late penalty once you do join. 
  • There is a premium for each plan offered.  While these premiums may be in some cases quite low – it is important to focus on the TOTAL ANNUAL ESTIMATED COSTS of your medications under each plan.  Part D plans not only have a premium, they also can come with deductibles as well as YOUR out of pocket costs for the medications you are taking.
  • On top of your Part B premium you may be subject to paying extra.  This extra amount is directly related to your income (2 years prior).  If your adjusted gross income filing individually is above $85,000 or jointly at $170,000 you will be subject to an extra monthly amount that you will pay.  This a confusing step and we take time with our clients to review these costs one on one. 
  • Your costs of each drug depend on the carrier and their corresponding plan. Medications under each plan are put into Tiers.  The higher the tier – the higher price you will pay for your drugs.  Not all drugs for each plan will be in the same Tier which means it is extremely important to pay close attention to how each plan breaks down your list of medications.  This is an extremely personal step in determining your drug coverage.  We stress the importance of this step with our clients – walking them through these costs so there are no surprises.  
  • There are also three levels of costs.  Initial costs, Coverage Gap or Donut Hole (Drugs get really expensive during this phase) and Catastrophic coverage.  

You reach the Coverage Gap when you and the insurance company have paid around $3,700. At this point you will be paying 40% for brand name drugs and 51% for generic drug in 2017

Catastrophic coverage kicks in when you have paid $4,950 out of your pocket for your drugs (this does not include your premium).  During catastrophic coverage, you pay either a 5% coinsurance for covered drugs or a co pay of $3.30 for generic covered drugs or $8.25 for covered brand name drugs, whichever is greater! 

  • Plan costs can change every year – it is important to review your plan each open enrollment period. (Oct15th – December 7th) – we review this with our current clients!

How can we help you?

Part D can end up being an incredibly costly piece of your HealthCare.  We give you peace of mind that the plans you are considering are the best coverage at the lowest annual cost! Examples of what we might do for you are:

  • Understanding creditable drug coverage
  • Doing a comprehensive analysis of your current medications to assist you in choosing the right Part D Plan
  • Reviewing your current medications annually to assist in you deciding to stay or switch plans
  • Assisting in the drug substitution approval process
  • Determining your Income Related Monthly Adjustment amount (IRMAA) – the extra amount you may have to pay

We are contacted/certified with several insurance carriers to represent their Prescription Drug plans.  This means we can offer you are broad look at all available plans in your area to ensure you are getting the right plan for YOU.