The Financial Guys

Prescription Coverage

Part D
Prescription Coverage

Medicare Part D helps cover the cost of prescription drugs. Part D is optional and only provided through private insurance companies approved by the federal government. However, Part D is offered to everyone who qualifies for Medicare. Costs and coverage may vary from plan to plan.

Female medicine doctor filling patient medical form or prescription

There are 2 ways to get Prescription (Part D) Coverage:

  1.  As a stand-alone prescription drug plan with Medicare: If you have Medicare Part A and Part B, you can add a Part D prescription drug plan to your existing coverage.
  2.  As part of a Medicare Advantage Plan (Part C): Medicare Advantage plans include all your Part A and Part B coverage. They may also include prescription drug insurance. Not all Medicare Advantage plans include prescription drug coverage.

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes. This list is called a drug formulary. The formulary may differ from plan to plan. Many plans arrange their list of covered drugs in different levels, called “tiers”. Generally, drugs in a lower tier will cost less than drugs in a higher tier. Here is one example of a typical Medicare drug plan’s tier system (but remember, your plan may be different):

Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Nonpreferred Brand
Tier 5: Specialty

The 4 Stages of Medicare Part D Drug Coverage

Annual Deductible

You are responsible for 100% of your prescription drig costs until your deductible is met. Your plan may have an annual deductible of no more than $590, but plans vary.

Initial Coverage

You pay up to 25% of co-insurance for medication covered in your plan's formulary. Max out-of-pocket is $2,000, then your plan kicks in to pay the rest of the medication included in the plan's formulary.

Catastrophic Coverage

After you reach your Tru Out-of-Pocket (TrOOP) costs for prescriptions, you pay NOTHING and your medication is 100% covered. Everything resets January 1st, and you return to the deductible stage at the beginning of each year.

HAVE QUESTIONS?
Contact Us

Phone : 833-628-0055
Email : info@thefinancialguys.com

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Location

305 Spindrift Drive.,
Williamsville, NY 14221

345 Winton Place,
Suite 120
Rochester, NY 14623

FOLLOW US ONLINE
HAVE QUESTIONS?
Contact Us

Phone: 866-834-2886
Email : info@thefinancialguys.com

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Location

305 Spindrift Drive.,
Williamsville, NY 14221

3445 Winton Place,
Suite 120
Rochester, NY 14623

319 West Main Street, Batavia, NY 14020