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Medicare Part D

Prescription Drug Plans

Part D Overview & Stages 4m 18s

How Drugs are priced...

Prescription Drug Plans in Medicare…

  • Part D Prescription Drug Plans are offered through a variety of insurance companies on a standalone basis or they can be included in your Medicare Advantage plan.  There are a number of standalone plans as well as Medicare Advantage plans with Part D coverage available in each state. Your most appropriate solution depends on the medications you anticipate filling and the pharmacy you prefer to shop.  Plans vary based on:
    • Formulary List
    • Tier assignments for each covered medication
    • Copay amounts during initial coverage stage
    • Network pharmacy selections

General information on Prescription Drug Plan Stages

Every Medicare Prescription Drug Plan (PDP) will have 4 stages of coverage depending on how high your medication costs may become during the year. Regardless of if you purchase a Standalone PDP Plan or you have a PDP coverage through your Medicare Advantage Plan, you will have 4 stages of coverage.

Part D High Income Surcharge- IRMAA

If you earn more than the base income tier, you will receive an income surcharge on your Medicare Part D Prescription Plan. This surcharge will be billed directly by Social Security with your Part B premium (if you are collecting Social Security Income, this amount is automatically withdrawn from your Social security check once you enroll in a Part D Plan.

Do I need a Prescription Plan if I don’t take Prescriptions?

Although you are not required to enroll in a Part D Prescription plan, there are two main issues with not enrolling: Penalties and Deadlines

Can I use outside discount drug programs (like GoodRx) with my Part D Plan?

Generally speaking you can use either your Part D plan or a drug discount card to purchase your medications. You cannot use both plans on the same medication. We recommend that you look up the price on the drug discount website before you go to the pharmacy. If the pharmacy quotes you a price with your Medicare plan that is more expensive than under the discount program, ask to fill your medication through the discount program instead of your insurance. Be mindful that many Medicare Prescription Plans have deductibles, so your medication cost may be high at first, but after your deductible is satisfied the cost may significantly drop. If you fill your medications outside of your plan, the price you pay will not go toward satisfying your deductible. So in some instances it may make sense to pay the higher cost of the medication under your plan and know that the cost will reduce once the deductible is satisfied.

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