Learn more about Medicare Part D costs
Original Medicare doesn't cover prescription drug costs, outside of medications prescribed to you during a hospital stay or outpatient visit. The good news is that Medicare Part D does cover them.
So what is Medicare Part D?
Medicare Part D is standalone insurance available through Medicare-approved private insurers like Anthem. Medicare Part D costs and coverage vary based on your location and the plan you select. But prescription drug costs are only one factor to consider when choosing a plan.
Check to make sure the plan covers the medications you need most. Insurers provide formularies, or drug lists, so you can see what medicines the plan includes. Also check to see if there are limitations or conditions for your drug coverage, such as prior authorization or step therapy.
Once you've found a few plans that cover your medications, you can do a Medicare Part D cost comparison.
What are Medicare Part D premiums and deductibles?
Most Part D plans have deductibles, premiums and/or copays or coinsurance for which you are responsible. Each year, the government sets a maximum limit on annual deductibles.
That limit is a good benchmark for comparing plan deductibles. Keep in mind that a plan with a $0 deductible may mean you'll pay higher copays and/or monthly premiums.
What are the Medicare Part D copay and coinsurance options?
Your copay is a set amount you pay for prescriptions when you pick them up at the pharmacy. Generic medications often cost less than brand-name prescription drugs, and you'll want that option in a Part D plan.
You'll find that more expensive medications usually have a coinsurance for you to pay. When you research your plan, see what your share of the cost will be for medications you need.
Know your drug tiers
Every drug on a drug list is in a cost-sharing tier. What you pay for your prescription depends, in part, on which tier your drug is in. Your prescription may fall under different drug tiers depending on its availability in generic or brand form, as well as the associated cost. Each drug tier has a set copay or coinsurance cost. Here's an example of how the tiers may work:
Tier 1: Preferred Generic. These are usually the lowest cost generic versions of brand-name drugs.
Tier 2: Generic. These are usually higher-cost generic drugs.
Tier 3: Preferred Brand. These are typically lower-cost, preferred brand-name drugs and some high-cost generic drugs.
Tier 4: Non-Preferred Drug. These are typically higher-cost, non-preferred generic and brand-name drugs.
Tier 5: Specialty Tier. Includes specialty drugs often used to treat serious illnesses. Drugs in this tier generally cost more than other drug tiers but may include both generic and brand-name drugs.
Tier 6: Select Care Tier. This drug tier usually includes select care drugs to treat specific medical conditions common among seniors, like diabetes, high blood pressure, high cholesterol and osteoporosis. This tier often has a $0 or very low copay.
Getting help with Medicare Part D costs
Costs for Medicare Part D can vary, and for those who need help, there is assistance available. Extra Help is a federal program that helps with Medicare Part D costs. Depending on your financial situation, it can pay for some or all of your prescription drug coverage.
Other ways to pay for Part D Medicare Costs
When researching your Part D plans, look at everything you pay for Medicare. For example, you may find that a Medicare Advantage plan or Part C can help you save. Many Medicare Advantage plans include prescription drug coverage as well as other benefits that give you bundled savings.
When you sign up for Medicare, look at all Part D plans that fit your drug coverage needs. Compare them with your Medicare costs and see what works for you.
