Standalone Prescription Drugs Plans

MEDICARE Prescription

Drug Plans

Medicare Prescription Drug Plans, also known as Medicare Part D plans, are insurance plans offered by private insurance companies approved by Medicare. These plans provide coverage for prescription drugs and are available to people who have Medicare Part A or Part B, or both.

Coverage for Prescription Drugs: Part D plans cover a wide range of prescription drugs, including brand-name and generic medications. Each plan has its own list of covered drugs, known as a formulary, which may vary in terms of the specific medications included and the cost-sharing requirements.
Monthly Premiums: Part D plans usually have a monthly premium that you pay to the insurance company. The premium amount can vary depending on the plan you choose and your income level.
Deductibles and Cost-Sharing: Part D plans may have an annual deductible, which is the amount you must pay out of pocket for prescriptions before your coverage kicks in. After meeting the deductible, you typically pay a copayment or coinsurance for each prescription, and the plan covers the rest up to a certain limit.
Coverage Gap (Donut Hole): Once you and your plan have spent a certain amount on covered drugs in a year, you enter the coverage gap, also known as the “donut hole.” During this phase, you’re responsible for a larger share of the costs of your prescriptions. However, discounts on brand-name and generic drugs apply, reducing your out-of-pocket costs.
Catastrophic Coverage: If your out-of-pocket spending reaches a certain threshold during the coverage gap, you qualify for catastrophic coverage. During this phase, you pay a smaller coinsurance or copayment for covered drugs for the rest of the year.
Enrollment: You can enroll in a Medicare Part D plan during your initial enrollment period when you first become eligible for Medicare, during the annual open enrollment period, or if you experience certain qualifying events.

It’s essential to carefully review and compare Part D plans to choose one that best fits your prescription drug needs and budget.

BENEFITS

Access

Part D plans provide coverage for a wide range of prescription drugs, including brand-name and generic medications. This coverage helps ensure that Medicare beneficiaries have access to the medications they need to manage their health conditions.

Cost Savings

Medicare Prescription Drug Plans can help reduce out-of-pocket costs for prescription medications. The plans typically cover a portion of the cost of each medication, reducing the financial burden on beneficiaries. This can be especially important for individuals with chronic conditions who require multiple medications.

Choice and Flexibility

Medicare beneficiaries have the opportunity to choose from a variety of Part D plans offered by private insurance companies. This allows beneficiaries to select a plan that best fits their individual medication needs and budget. Beneficiaries can also switch plans during the annual enrollment period if their medication needs change.

MEDICARE ADVANTAGE PLAN TYPES

Medicare Advantage Plans have networks, which are lists of doctors and hospitals who participate in the plan. These networks can give Medicare Advantage members convenient access to medical care at reasonable costs. There are various types of Medicare Advantage Plans and the two most common are HMO’s and PPO’s. Here are the key features and differences between the two types of plans.

PPO – Preferred Provider Organization

Has a network of preferred doctors & hospitals, usually nationwide.
The plan is flexible and allows you use out of network doctors, but for higher co-pays than in network.
You are covered anywhere in the event of an emergency or urgent care situation.
No referrals are needed to see a specialist doctor.
Best if you travel or want more flexibility and choice with seeing healthcare providers.

HMO – Health Maintenance Organization

Has a local, multi county, network of preferred doctors & hospitals.
You need to use this network of doctors & hospitals for scheduled medical care.
You are covered anywhere in the event of an emergency or urgent care situation. You will need a referral to see a specialist doctor.
Best if you want the most benefits at the lowest cost and are good with using the plan’s doctors and other rules.

MEDICARE ADVANTAGE VS ORIGINAL MEDICARE

As mentioned above, you have two ways to receive your primary Medicare benefits; Medicare Advantage and Original Medicare. The chart below gives you a comparison of the main features.

Feature

Original Medicare

Medicare Advantage

Total Monthly Cost Estimate

$164.90 in 2023

$104.90 – $164.90 in 2023

Part A & B Medical Included?

Yes

Cap On Annual Medical Bills Included
(Max out of pocket protection)

No, you can buy a Medicare Supplement (Medigap)

Yes

Doctor Networks

No – Open

Yes

Pharmacy Benefits (Part D)?

No, you can buy a Part D plan.

Yes, Part D is usually included, unless you choose a plan without it.

Dental, Vision, Hearing

Yes, typically included.

Fitness Membership

Yes

SAMPLE MEDICARE ADVANTAGE PLAN

What A Typical Medicare Advantage Plan Can Look Like

Benefit

Copy or Allowance

Annual Deductible

Preventive Medicine

$0 copays

Doctor Visits

$5 Copay Primary Care

$30 Copay Specialist

Outpatient Surgery & Procedures

$150 – $300 copay

Hospital Stay

$100 – $300 copay per day for days 1-5, $0 copay each day above 5

In Network Max Out Of Pocket Protection
(The most you pay for medical care annually)

$3,400 – $6,700

Pharmacy Benefits (Part D)?

Generic: $0 deductible / $0 – $10 copay

Brand: $0 – $200 deductible / $40 copay

Dental

Coverage for cleanings, fillings, crowns, dentures, and other services, $2,000 – $3,000 in annual benefits

Vision

$0 cost annual eye exam, $200 allowance for eye glasses or contacts.

Hearing

$0 cost annual hearing exam, allowance or copay for hearing aids.

Gym / Fitness

Silver Sneakers membership for free access to participating gyms

Other Possible Benefits

Over the counter medicine & vitamins, flex spending cards, transportation.

*The benefits and comparisons listed in the two charts above are for general information purposes. They do not represent specific plans and benefits are not guaranteed. For plans you are considering, review the Summary of Benefits and Evidence of Coverage. Contact us for specific plan options available to you.

WHO CAN BENEFIT FROM MEDICARE ADVANTAGE?

Medicare recipients who want the most value from Medicare and lowest monthly cost.
Veterans, Retired Military, & Their Families can benefit from plans specially designed for them. Plus, Medicare Advantage works with Tricare & CHAMPVA.
Those receiving Medicare from disability and are under age 65.
Medicare recipients who are moderate to low income and / or have Medicaid.

Frequently Asked Questions

When can I sign up for a Medicare Advantage Plan?

There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th. There may also be other special situations that make you eligible. To get information and enroll in a plan, simply contact us on this site or give us a call at 855.625.7633 toll free.

Standalone Prescription Drugs Plans

MEDICARE Prescription

Drug Plans

BENEFITS

Access

Cost Savings

Choice and Flexibility

MEDICARE ADVANTAGE PLAN TYPES

PPO – Preferred Provider Organization

HMO – Health Maintenance Organization

MEDICARE ADVANTAGE VS ORIGINAL MEDICARE

SAMPLE MEDICARE ADVANTAGE PLAN

WHO CAN BENEFIT FROM MEDICARE ADVANTAGE?

Frequently Asked Questions

When can I sign up for a Medicare Advantage Plan?

How do I sign up for a Medicare Advantage plan?

Will Medicare Advantage and it’s extra benefits cost me more monthly?

How does Medicare Advantage provide extra benefits for no extra monthly cost?

Will having Medicare Advantage lower the quality of my coverage or care?

If I sign up for Medicare Advantage, can I keep my doctors or will I need to change them?

If I enroll in a Medicare Advantage plan, can I change to another one or go back to regular Medicare?

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