Prescription Drug Plans

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Prescription Drug Plans in Lafayette, IN

Medicare Part D is prescription drug coverage.

Medicare Plans and Education - Medicare Prescription Drug Plans in Lafayette, IN

Basics of Part D Drug Plans

  • Medicare Part D is prescription drug coverage.
  • It is an optional benefit offered to everyone who has Medicare to help pay for prescriptions drugs.
  • It is offered by private insurance companies.
  • Part D plans have 5 payment stages (Annual Deductible / Initial Coverage / Coverage Gap (aka 'the donut hole' /Catastrophic Coverage)
  • If you decide NOT to get Medicare Part D when you're first eligible, you'll likely pay a late enrollment penalty.
  • However, there is no late enrollment penalty if one of these situations apply:
  1. You have other credible prescription coverage through your employer, union, TRICARE, the VA benefts or private ACA healthcare plan.
  2. You qualify and are receiving Extra Help through your state

Two Ways To Get Prescription Drug Coverage:

  1. Through a "Stand Alone" Part D plan .

     2. Through Medicare Advantage Plans (Part C)

What Medicare Part D Plans Cover:

  • Standardized -Each plan must give at least a standard level of coverage set by Medicare.
  • Formulary -Each private insurance companies plan has its own drug list called a formulary
  • Tiers -Most plans use tiered formularies  to group covered drug according to cost.
  • Drug costs usually rise in cost as the Tier Number increases.
  • (Tier 1- Preferred generic drugs $ / Tier 2- Generic drugs $$ / Tier 3- Preferred Brand Name Drugs $$$ /  Tier 4 - Non-Preferred Drugs $$$$ / Tier 5- Specialty Drugs $$$$$ )
  • Quality limits -Quality limits may be set by the plan or by Medicare.  Quality limits are in place to ensure safe and effective use of the drug.
  • Star Ratings -Medicare uses a 5-star rating system to measure how well plans sponsors perform in different categories.  These ratings help consumers compare plans based on quality and performance, with 1 star being the lowest score and 5 the highest.

Protect your health and review your Medicare options.

Costs for Medicare drug coverage

  • You'll make these payments throughout the year in a Medicare drug plan:
  • Plan Premium - varies from plan to plan and insurance company sponsoring the plan
  • Yearly deductible - although some plans waive deductibles on some or all of the plans different Tiers
  • Co-payment or co-insurance -vary from plan to plan
  • Cost in the coverage gap if you reach this stage - set by Medicare
  • Late penalty fee if you enroll in Part D late

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary 
  • Whether you get Extra Help paying your Medicare Part D costs

**Tip- Use the Medicare Plan Finder Tool or consult with an independent insurance agent who can help you "shop" plans in your county to find you a plan covering your prescriptions at the most reasonable annual out-of-pocket cost for you.

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