fbpx

Ashford Insurance

Medicare Part D

Prescription Drug Plans Made Easy

Medicare Part D

Unlike private health insurance plans, Original Medicare (Medicare Parts A and B) does not cover prescription drugs. Medicare Part D was established in 2003 to provide prescription coverage for Medicare enrollees and requires buying a private prescription plan.

There are a few avenues for obtaining prescription coverage once you’re eligible for Medicare, which is typically age 65 (or younger if you meet disability qualifications). The options are:

  • A stand-alone Medicare Part D Prescription Drug Plan, which can be used in tandem with Original Medicare
  • A Medicare Advantage plan that includes Part D prescription drug coverage (these Medicare Advantage plans are known as MAPDs). Many Medicare Advantage plans are MAPDs.
  • Supplemental coverage from Medicaid (the coverage will be via Part D) or your employer or a spouse’s employer (including retiree coverage that’s considered comparable to Part D coverage).

Ashford Insurance can help you get the prescription coverage you need.

Texas Medicare Part D Prescription Drug Plans is coverage for retail prescription drugs or the medications that you pick up at a pharmacy. This is a voluntary program that allows you to access medications at an affordable rate and insures yourself against any prescriptions you may need in the future.

All Medicare Part D Prescription Drug plans cover the types of drugs most often prescribed for people enrolled in Medicare. This is decided by the U.S. government. But it’s up to each plan which specific brand name and generic drugs they will cover within those types. You can find this information by viewing a plan’s drug list.

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 own 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 in 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 distinct levels of qualification, and your subsidy level determines how much assistance you will get towards 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.

A drug list—sometimes called a formulary—is a list of drugs covered by a plan.

  • A drug list can change from year to year.

    Part D plans may add or remove drugs from their drug list each year. Changes may also be made during the year, for example, if a drug is taken off the market. Your plan will let you know if a change affects a drug you are taking.

  • Many Part D plans have a tiered drug list where drugs are divided into groups based on cost.

    In general, drugs on low tiers cost you less than drugs on high tiers. Plans may charge a deductible for certain drug tiers and not for others, or the deductible amount may be different depending on the tier.

There are rules for some prescription drugs that limit how and when a plan will cover them. These are called requirements or limitations. If you don’t follow these rules or don’t get permission from the plan saying you don’t have to (called an exception), you may have to pay the full cost of the drug out of your own pocket.

WHAT IS ‘THE DONUT HOLE’?

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

Learn about the Medicare Part D Late Enrollment Penalty Here

Some Texas Medicare Advantage Prescription Drug plans and stand-alone Medicare Prescription Drug Plans provide partial or full coverage during the coverage gap. For example, some plans may not have a gap at all, while others may offer generic drug coverage in the gap. Plans with gap coverage may charge a higher monthly premium, so you should only consider one of these plans if you have high prescription drug costs and know you will reach the coverage gap.

There is a Late Enrollment Penalty for not having creditable prescription coverage. 

Ashford Insurance also offers Medicare Advantage (Part-C) and Medicare Supplements (Medigap) Insurance Plans.

Learn About the “Donut Hole” Here

Need help? Call us for an appointment at (817) 952-3153

Ashford Insurance is an independent health insurance agency specializing in Texas Medicare insurance and has been helping seniors since 2005.  Ashford Insurance is here to help you understand Medicare and health insurance in simple, plain terms that anyone can grasp.  We specialize in assisting folks who are Medicare eligible to learn about the coverage options available through the Medicare Health Insurance Program. 

Ashford Insurance Agents

Our Products

Here is a partial list of the products offered by Ashford Insurance

Medigap Insurance

Medicare Supplements

Dual Medicare Plans

Got Medicare & Medicaid?

Chronic Needs

Special Need Plans

Prescriptions

Prescription Drug coverage

Dental Insurance

Dental Insurance Plans

Life Insurance

Life Insurance Plans

Funeral Insurance

Burial Insurance

Short Term Medical

Temporary Insurance Coverage

Health Insurance

ACA FFM Exchange

Notary Services

Notary Public

Contact Form

(817) 952-3153

M-T 9:00 – 4:00
F 9:00- 12:00

Weekends & Evenings by Appointment

Address

 1245 Southridge Court Suite 101, Hurst, TX, 76053

* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.

Recent Blog Articles

Finding a Reliable Medicare Insurance Agent: Your Guide to Making an Informed Choice

Finding a Reliable Medicare Insurance Agent: Your Guide to Making an Informed Choice

Navigating the complex world of Medicare can feel overwhelming, especially with the deluge of mail and calls you receive once you turn 65. Everyone seems to promise the “best plan,” but making a hasty decision can have long-term consequences. That’s where a trustworthy Medicare supplement insurance agent can be your guiding light, ensuring you make informed choices that align with your needs and best interests.

Read More »
Scared Senior

Halloween is Not as Scary as Large Physicians Group

It happens every couple of years. A Physicians Group’s contract with a large insurance carrier is coming up for renewal. How wrong is it for a Health Physicians group to SCARE Seniors who depend on their services? It would seem like it’s just a type of corporate blackmail to me.

Read More »
Navigating Medicare Special Enrollment Periods: When Life Takes Unexpected Turns

Navigating Medicare Special Enrollment Periods: When Life Takes Unexpected Turns

Medicare, the vital healthcare program for seniors and certain individuals with disabilities, is known for its well-defined enrollment periods. However, life is unpredictable, and sometimes circumstances change when you least expect it. That’s where Medicare Special Enrollment Periods (SEPs) come into play. These SEPs provide you with an opportunity to adjust your Medicare coverage when specific life events occur.

Read More »