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“We do not offer every plan available in your area. Currently we represent 7 organizations which offer 54 products in your area. You can always contact MEDICARE.gov, 1-800-MEDICARE or your local state health insurance program for help with plan choices..”
Prescription drug coverage
There are 2 ways to get prescription drug coverage through Medicare, either by a stand alone Drug plan or through a Medicare Advantage plan with drug coverage. To get Part D you must have and/or be eligible for Part A and B. Prescription drug plans cover drug purchased through a retail pharmacy or mail order pharmacy.
Like Part B, there is a penalty for not taking Part D when first eligible. That penalty is 1% per month you go w/o a drug plan until you enroll in one for the average cost of a drug plan (Approx. $35.00 monthly).
**Example not enrolled for 12 months .35 x 12 = $4.20.
Also, the IRMAA applies to Part D as well, get the upcharges here. View IRMAA
All Part D drug plans have to follow rules set by Medicare. RX Plans have to carry 2 drugs minimum in each family of their formulary* for a particular condition. All Part D plan are subject to various "Enrollment Periods" For a list click here. Every drug plan works on a tiered system of pricing there are up to 6 tiers to drug plans available in our area.
Drug Plan Tiers:
- Tier 1 is Preferred Generic
- Tier 2 Non-Preferred Generic
- Tier 3 Preferred Name Brand
- Tier 4 Non-Preferred Name Brand
- Tier 5 Specialty Drugs (Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing.)
- Tier 6 drugs are available on select drug plans.
Every Drug Plan has 4 "Stages" works on a calendar year.
- Deductible (if applicable) once you pay the deductible you go to the Initial Coverage Stage
- Initial Coverage Stage, after you paid the deductible then you pay a straight co-pay/co-insurance for your drugs up to a retail cost limit of $2000.00 for 2025. Once you reach the retail cost limit you move into Catastrophic Stage.
- Coverage Gap HAS BEREN ELIMINATED FOR 2025.
- Catastrophic Coverage In this stage you pay NOTHING for covered drugs.
*It is very important that you do and annual review of your prescription drug plan as the plan can change drugs in and out of a formulary and once December 7th passes you are locked into the plan you are on until next open enrollment (October 7th thru December 7th)