Hurst Medicare Part D Prescription Drug Plans

Parts A and B of Medicare cover most of your healthcare costs, but they don’t cover prescription drugs that you fill at a pharmacy. You can buy a Part D plan from a private insurer to help cover these expenses.

You can accomplish this in one of two ways: If you have original Medicare, you can buy a stand-alone Part D plan. Or you can purchase a Medicare Advantage plan that combines medical and drug coverage in its benefits package.

You’ll likely have many Part D plans to choose from. In 2023, the average Medicare beneficiary has 23 Part D stand-alone plans to choose from and 31 for drug coverage within a Medicare Advantage plan. The premiums and costs for your medications can vary by plan, and some plans require you to pay an annual deductible before coverage kicks in.

Make sure the medications you take are included in a plan’s formulary. Also, find out how much you would have to pay from your pocket for the prescriptions you take regularly.

Most plans have several pricing tiers with various levels of out-of-pocket costs. You may have a $1 copayment for preferred generic drugs, $5 for other generics, and $20 for preferred brand-name drugs. You may be required to pay 20 percent or more of the cost for other brand-name drugs and specialty medications. Some plans require coinsurance for all the drugs they cover.

Your insurer may require prior authorization for certain drugs, limit the number of doses covered in each period or require you to use other specified drugs in the same therapeutic category before you can receive what may be your preferred prescription. Nearly half the drugs in many plans’ formularies had one of these restrictions in 202.

Formularies and drug tiers can change, so it’s important to recheck your plan every year during open enrollment. You can sign up for Part D or switch plans from Oct. 15 to Dec. 7 each year, with coverage starting Jan. 1. You can find out whether and how plans in your area cover your medications by using Medicare’s Plan Finder or checking with insurers directly.

Some plans have their network of pharmacies while others offer nationwide access to drugstores. You may have lower out-of-pocket expenses if you use a preferred pharmacy within the plan’s network. Plans also may offer a mail-order service, which usually has lower cost-sharing than what you would pay at a pharmacy down the street.

How much you’ll pay for your prescriptions depends on the plan you choose and the medicines you take. Here’s a breakdown of the costs:

If you have original Medicare and buy a stand-alone Part D drug plan, you’ll pay a monthly premium that the plan sets. If you choose a Medicare Advantage plan with drug coverage, you’ll generally pay one monthly premium for all benefits — hospital, medical, and prescription drugs.