Medicare Part D
Medicare Part D
Medicare Part D provides coverage for prescriptions and some vaccines.
Coverage Includes:
- Drugs most commonly prescribed for Medicare beneficiaries as determined by federal standards.
- Specific brand name drugs and generic drugs included in the plan’s formulary (list of covered drugs)
- Commercially available vaccines not covered by Part B Coverage
Part D plans typically do not cover:
Drugs not listed on a plan’s formulary
Drugs prescribed for anorexia, weight loss or weight gain
Prescriptions for fertility, erectile dysfunction or cosmetic purposes
Prescription vitamins and minerals
Non-prescription drugs (e.g. over-the-counter medications)
You can get prescription drug coverage through a private insurance company in two ways: a stand-alone Part D plan, or with a Medicare Advantage plan that includes prescription drug coverage.
Things to Consider when choosing a Part D plan:
Costs vary by plan and provider
Each plan negotiates prices with drug manufactures and pharmacies. Your copays and coinsurance rates are based on these prices and on guidelines set by Medicare. Stand-alone Part D plans charge a premium, and the amount will vary based on the plan and the provider. Some plans may charge a deductible, and others don’t.
Each plan has its own formulary (drug list)
A formulary is a list of prescription drugs covered by a plan. Medicare sets standards for the types of drugs Part D plans must cover, but each plan chooses the specific brand name and generic drugs to include on its formulary.
Some plans have network pharmacies
Some plans have a network of pharmacies for you to choose from, while other plans may offer nationwide coverage. If a plan has a network of pharmacies, your costs may be different if you fill a prescription outside the network.
Your costs can vary by the drug stage you are in
There are four stages, and it’s important to understand how each one impacts your prescription drug costs. You may not go through all the stages. People who take few prescription drugs may remain in the annual deductible stage or move only to the initial coverage stage. People with many, or high-cost medications, may move into the coverage gap and/or catastrophic stage.
Please contact Andrew Six Insurance to learn more about your options!
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