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What Do Prescription Drug Plans Cover?

Since Part D is offered through private insurance, you’ll find coverage differences between plans. While the specific medications it covers may be different, they all have to provide coverage for at least two low-cost medications for drugs in protected classes. Protected classes are for medications that treat cancer and/or HIV/AIDS.

The list of medications is called the formulary. Have your list of medications ready when you first sign up to see if the plan you’re interested in has a formulary that matches your medication needs. We will work with you to find a plan that covers most (if not all) of your medications.

When Can I Join?

You can join Part D during one of these times:

• Initial Enrollment - Seven months, ranging from three months before you turn 65 to three months following the month you turned 65

• Annual Election - October 15 to December 7

• Special Enrollment - Within 63 days after you lose creditable prescription drug coverage through another insurer

How Much Do I Pay?

The payments are highly variable from one plan to another. While there is not a universal answer for how much you will pay in coinsurance, deductibles, or premiums, there are some metrics that will give you an idea of how much you can expect to pay:

• Typically, premiums cost roughly $33.06 (also known as the “national base beneficiary premium”)

• Deductibles range in cost, but no deductible will charge more than $445 annually

• Coinsurance depends on which tier your medication belongs to

Tiers are arranged in order of least to most expensive, with generic medications being on the first tier, and specialty drugs being on the last.

The tiers are:

• 1 - Generic drugs

• 2 - Brand name (preferred)

• 3 - Brand name (not preferred)

• 4 - Specialty

Your plan will try to align you with a medication on the lowest tier, though this may require your doctor to prescribe you a different medication similar to the one you were previously prescribed.

Are There Any Medicare Plans That Already Have Part D Included?

Yes. This is possible through Medicare Advantage, which is also limited to private insurance. Not all Medicare Advantage plans cover prescriptions, so it is important to make sure that the one you’re interested in covers prescription drugs.

You can join Medicare Advantage during the Annual Election Period as long as you’re enrolled in Medicare Part A and B.

For More on Medicare Drug Plans

Do you have any questions? If so, Cashmore Financial Group can be the answer to your prescription drug needs! We can help make Part D enrollment fast and easy, providing excellent customer service that makes us your go-to for all things related to Medicare.

How can we help you?