|| IF YOU MISSED THE STANDARD HEALTH INSURANCE OPEN ENROLLMENT PERIOD – NO WORRIES! CONTACT ME TODAY TO LEARN HOW YOU MAY STILL QUALIFY FOR A SPECIAL ENROLLMENT PERIOD AND GET HEALTH COVERAGE NOW. || || The Medicare Advantage Open Enrollment Period is from January 1st to March 31, 2025. This is when individuals already enrolled in a Medicare Advantage plan can switch to a different plan or return to Original Medicare. ||

PRESCRIPTION DRUG INSURANCE

Prescription drug insurance is essential as many prescription drugs are expensive and can cost thousands of dollars per month.

Steve Turner
Insurance Agent & Broker

Do I Need Prescription Drug Insurance?

Yes, prescription drug insurance can be important because many prescription drugs are expensive and can cost thousands of dollars per month. Prescription drug insurance can help lower pharmacy costs and make it easier to get medications.

It’s important to evaluate your healthcare needs and preferences when considering a Medicare Advantage plan, Medicare Supplement plan or Prescription Drug plan.

Here’s how I can help. Before you enroll in a prescription drug plan, I’ll do a complimentary needs analysis and carefully review the plan’s benefits and costs with you. There’s no obligation to buy anything. After our consultation, if you decide to choose me as your Agent, you won’t have to call an (800) number anymore. If you have questions, concerns, or issues about your Prescription Drug plan throughout the year, you can contact me directly.

HOW I CAN HELP YOU

KEY DETAILS

Enrollment:

To receive coverage for prescription drugs, you must enroll in Medicare Part D. You can do this during your initial enrollment period or during the annual open enrollment period, which typically runs from October 15th to December 7th each year.

Plan Types:

There are two main types of Medicare Part D plans: standalone prescription drug plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans.

PDPs work with Original Medicare, while MA-PD plans to combine prescription drug coverage with other health benefits private insurance companies offer.

Cost:

Medicare Part D plan costs can vary depending on the plan you choose, your income, and the medications you take.

Most plans have a monthly premium, an annual deductible, copayments or coinsurance, and a coverage gap known as the “donut hole.”

Formulary:

Each Part D plan has a formulary and a list of prescription drugs that the plan covers. Formularies can vary between plans, so choosing a plan that covers the medications you need is important.

Coverage Gap:

If your total drug costs reach a certain threshold each year, you may enter the coverage gap (or “donut hole”), where you will be responsible for a larger portion of the cost of your medications.

In 2023, the coverage gap begins after you and your plan have spent $4,660 on covered drugs.

In 2025, the coverage gap goes away.

Catastrophic Coverage:

Once you reach a certain out-of-pocket threshold, you will enter what is known as catastrophic coverage.

At this point, your plan will pay for most of your remaining drug costs for the rest of the year.

Extra Help:

If you have limited income and resources, you may be eligible for extra help to pay for your Medicare Part D premiums, deductibles, and copayments.

ADVANTAGES

Lower out-of-pocket costs
Cost protection
Flexible plan options
Coordination of care
Utilization management tools
Assistance for those with limited resources

DISADVANTAGES

Cost
Coverage gap
Late enrollment penalty
Drug list
Plan differences
Prior authorization

PRESCRIPTION DRUG FAQ

Prescription drug insurance is available as a stand-alone plan. It works similarly to medical insurance: You pay an annual premium and then have a copay or coinsurance cost at the pharmacy. The most well-known type of stand-alone plan is Medicare Part D, though privately-run plans exist.

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.

What if I want to be in another prescription drug plan? You can change Medicare prescription drug plans for any reason.

Deductibles vary between Medicare drug plans. In 2024, no Medicare drug plan may have a more than $545 deductible. Some Medicare drug plans don’t have a deductible, and in some plans that do have a deductible, drugs on some tiers are covered before the deductible.

Understanding the stages of your Medicare prescription drug coverage may help you manage your costs over the plan year.

Stage 1—Deductible Stage.
Stage 2—Initial Coverage Stage.
Stage 3—Medicare Part D Coverage Gap. (Goes away starting 2025)
Stage 4—Catastrophic Coverage.

You can try generics, biosimilars, or other alternatives if your prescription is not covered. You also may qualify for patient assistance and manufacturer copay programs that can help you cover costs. You can ask for an exception if an insurance company won’t cover your medication.

Starting in 2025, the Medicare Prescription Payment Plan provides the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription.

This program, called the Medicare Prescription Payment Plan, will help people with high-cost sharing earlier in the plan year by spreading out those expenses over the course of the plan year.

While the lower-tier drugs may be manageable to pay for without Part D coverage, the higher tiers may give you sticker shock. So, while you may have to pay a premium, deductible, copay, or coinsurance, your overall Medicare Part D costs will likely be significantly less than if you don’t have coverage.

If you pay health or prescription drug costs because they aren’t covered by Medicare or other insurance, this out-of-pocket cost will be capped at $2,000 starting in 2025.

Income-Related Monthly Adjustment Amounts (IRMAA) explained

Depending on your income, your monthly Medicare Part B or Part D premiums may be higher due to an Income-Related Monthly Adjustment Amount (IRMAA)
Part B IRMAA started in 2007 as a result of the Medicare Modernization Act of 2003
Part D IRMAA started in 2011 as a result of the Affordable Care Act of 2010

Eligible Income

Medicare defines the income used to determine IRMAA as “adjusted gross income plus any tax-exempt interest.”
Also known as Modified Adjusted Gross Income
Examples include:
Wages
Social Security Benefits
Capital Gains
Dividends & Pensions
Rental Income
Tax-deferred distributions from 401(k)s or IRAs

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Email: steve@steveturnerinsurancespecialist.com

Phone and Text: +1.813.388.8373

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PRESCRIPTION DRUG INSURANCE