Medicare Part D Prescription Drug Plans
Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. Part D helps pay for brand-name and generic prescription drugs. Medicare describes Part D as optional coverage offered to everyone with Medicare by private companies approved by Medicare.
National Benefits Consultants helps Colorado Medicare beneficiaries compare Medicare Part D prescription drug plans, drug formularies, pharmacy networks, costs, and coverage options.
National Benefits Consultants helps Colorado Medicare beneficiaries compare Medicare Part D prescription drug plans, drug formularies, pharmacy networks, costs, and coverage options.
How Medicare Part D Works
Medicare Part D can be added to Original Medicare as a standalone prescription drug plan. Some Medicare Advantage plans also include prescription drug coverage, often called Medicare Advantage Prescription Drug plans.
If you have Original Medicare and a Medicare Supplement policy, you generally review a separate Part D prescription drug plan. If you enroll in a Medicare Advantage plan with drug coverage, your medical and prescription drug coverage are usually bundled through that plan. Medicare explains that people can get Part D as a separate Medicare drug plan or through a Medicare Advantage plan with drug coverage.
If you have Original Medicare and a Medicare Supplement policy, you generally review a separate Part D prescription drug plan. If you enroll in a Medicare Advantage plan with drug coverage, your medical and prescription drug coverage are usually bundled through that plan. Medicare explains that people can get Part D as a separate Medicare drug plan or through a Medicare Advantage plan with drug coverage.
Why Part D Plan Comparison Matters
Part D plans are not all the same. A plan that works well for one person may not be a good fit for someone else.
Before choosing a Medicare Part D plan, review:
Before choosing a Medicare Part D plan, review:
- Are your prescriptions covered?
- What tier is each medication on?
- What pharmacies are in network?
- Are preferred pharmacies available?
- What are the monthly premium, deductible, copays, and coinsurance?
- Are prior authorization, step therapy, or quantity limits required?
- Does the plan fit your current medication list?
- Should the plan be reviewed again during the Annual Enrollment Period?
Drug Formularies and Pharmacy Networks
A Part D formulary is the list of medications covered by the plan. Formularies can differ from one plan to another. A medication covered well by one plan may be more expensive or less favorable on another plan.
Pharmacy networks also matter. Medicare explains that some plans only cover drugs when filled at in-network pharmacies, and preferred in-network pharmacies may offer lower costs.
This is why reviewing both medications and pharmacies is important before choosing a plan.
Pharmacy networks also matter. Medicare explains that some plans only cover drugs when filled at in-network pharmacies, and preferred in-network pharmacies may offer lower costs.
This is why reviewing both medications and pharmacies is important before choosing a plan.
Part D Plan Rules
Medicare Part D plans may have rules that affect how prescriptions are covered. These can include prior authorization, step therapy, quantity limits, medication safety checks, and other drug management programs. Those rules do not always mean a plan is bad, but they should be understood before enrolling.
Part D Late Enrollment Penalties
Even if you do not take many prescriptions now, Part D timing still matters. Medicare says people may owe a Part D late enrollment penalty if they go 63 or more days in a row without Medicare drug coverage or other creditable prescription drug coverage after their Initial Enrollment Period ends. That penalty can be added to your monthly premium for as long as you have Part D coverage, so it is important to understand your timing and whether you have creditable drug coverage.
Extra Help With Prescription Drug Costs
Some Medicare beneficiaries may qualify for Extra Help, a Medicare program that helps people with limited income and resources pay Part D premiums, deductibles, coinsurance, and other prescription drug costs. If prescription drug costs are a concern, it may be worth reviewing whether Extra Help could apply.
When Should You Review Part D?
Part D should be reviewed when you first become eligible for Medicare and again during appropriate enrollment periods. It may also make sense to review Part D when your medications change, your pharmacy changes, or your current plan changes its formulary or costs. The fall Medicare Annual Enrollment Period (AEP) is a common time to review drug coverage for the coming year.
How National Benefits Consultants Helps
National Benefits Consultants helps Medicare beneficiaries review prescription drug coverage as part of the broader Medicare decision.
We can help you review:
We can help you review:
- Current prescription drug list
- Part D plan options
- Drug formularies
- Pharmacy networks
- Preferred pharmacy choices
- Premiums, deductibles, copays, and coinsurance
- Medicare Advantage drug coverage
- Part D timing and late enrollment penalty issues
- Annual plan review needs
Need Help Reviewing Medicare Part D?
Need help comparing Medicare Part D prescription drug plans, Medicare Advantage drug coverage, Medicare Supplement Insurance, or other Medicare coverage options? Call 720-488-9892 or contact National Benefits Consultants to review your Medicare coverage choices.