Hurst Prescription Drug Plans

Original Medicare Parts A and B don’t include prescription drug coverage. A Medicare Prescription Drug (Part D) plan can help cover the costs of your medication. Ashford Insurance offers prescription drug (PDP) plans to help you save money and give you peace of mind—even if your health changes. Plans include commonly used generic and brand-name prescription drugs, but each plan has slightly different coverage and drug lists.

Hurst, Texas Part D Medicare Prescription Drug Plans is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare or as a set of benefits included with your Medicare Advantage Plan.

Unless you have creditable drug coverage and will have a Special Enrollment Period, you should enroll in Part D when you first get Medicare. If you delay enrollment, you may face gaps in coverage and enrollment penalties.

Medicare Part D costs vary depending on the specific drug plan chosen. Generally, you are responsible for paying a monthly plan premium, and then deductibles and copays (or coinsurance) for your medications. People with higher incomes may have to pay more for the cost of their plan.

There are many Texas Medicare Part D plans to choose from, with plans ranging from $15.00 – $100.00 on up. Choosing your drug plan should never be based purely on the plan’s monthly premium because every plan has its separate premium, drug formulary, and copay.  Just enrolling in the cheapest plan without checking the plan’s formulary could lead you into paying higher out-of-pocket costs for the year. This could be an expensive mistake, especially if you learn later that the plan does not cover one of your medications. Remember, the least expensive monthly premium is not necessarily the least expensive plan when figuring out total prescription costs. Also, do not forget, all Part D plans, the benefits, formulary, pharmacy network, provider network, premium, and/or copayments/co-insurance may change on January 1 of each year.

Extra Help

The federal government offers extra help with paying for your Part D drug plan and paying for your medications if you qualify and is based on income. This is what is called a Low-Income Subsidy. Anyone can apply for this from Social Security at any time. Help is only awarded based on proving low income and limited resources. You must have an annual income that falls below 150% of the Federal Poverty Level based on your household size.

Beneficiaries who qualify may receive assistance with paying their monthly Part D premiums, their annual Part D deductible, and their co-payments on retail medications. There are diverse levels of qualification, and your subsidy level determines how much assistance you will get in your premiums. Someone qualifying with a full subsidy would have 100% of their Part D premium paid for, up to the benchmark allowed by Medicare for that particular year.

The Gap

The Medicare Part D coverage gap, also known as the “donut hole” is a benefit structure that applies both to stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans, however, not everyone enters it. If you’re presently or will sometime in the future be taking medications or are concerned about lowering your prescription drug costs, it may be helpful for you to understand what the Medicare ‘Donut Hole’ is and ways to avoid it.

Donut Hole (Coverage Gap) Explained

The coverage gap commonly referred to as “The Donut Hole” has several phases.

The coverage gap is a temporary limit on what most Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans pay for prescription drug costs. While you’re in the coverage gap, you might pay higher costs for brand-name and generic drugs. Below we’ve described each phase:

Deductible phase: For most stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans, you’ll pay 100% for medication costs until you reach the yearly deductible amount (if your plan has one). The standard deductible for 2023 is $505.

Initial coverage phase: After you’ve reached the deductible, you’ll enter the initial coverage phase, where you will pay the plan’s cost share for covered medications. For example, if your plan benefit includes a 25% coinsurance in this phase and you’re taking a medication that costs $400 a month, your out-of-pocket cost would be approximately $100 a month.

The coverage gap, also known as the “donut hole”: begins if you and your plan spend a combined $4,660 in 2023 as described above. While in the coverage gap, you’ll typically pay 25% of the plan’s cost for brand-name drugs and generic drugs in 2023. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $7,400 in 2023.

Catastrophic coverage phase: Begins if your out-of-pocket costs reach $7,400 in 2023. During the catastrophic coverage phase, you’ll only pay a small coinsurance or copayment for covered prescription drugs for the remainder of the year.

Why would someone want a Medicare Prescription Drug Plan?

There are many reasons why someone on Medicare might want a Prescription Drug Plan (PDP). Here are a few:

• To save money. Prescription drugs can be expensive, and a PDP can help you save money on the cost of your medications. In fact, studies have shown that Medicare beneficiaries who have a PDP save an average of $1,200 per year on their prescription drug costs.
• To have more choices. A PDP gives you more choices when it comes to your prescription drugs. You can choose a plan that covers the drugs you need, and you can switch plans each year if you find a better option.
• To get help with your medications. A PDP can help you with your medications in several ways. For example, many plans offer mail-order pharmacy services, which can make it easier to get your medications. Additionally, some plans offer programs that can help you pay for your medications if you have financial difficulties.

If you are on Medicare and you take prescription drugs, then a PDP is a good option to consider. PDPs can help you save money, have more choices, and get help with your medications.