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How Do Prescription Drug Plans Work?

Here is important information you need to know about owning a prescription drug plan:

Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $415 in 2019. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2019, the initial coverage cap is $3,820. After you and the insurance company together have paid this amount, then you enter the coverage gap.
The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $5100 out of your own pocket in 2019.
Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.

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Disclaimers

MedicareJose.com is owned and operated by independent licensed insurance agents/brokers. MedicareJose.com is a privately owned, non-government website and is not affiliated with or endorsed by Medicare.gov, CMS, Social Security, any government agency, or Facebook.

We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or call 1-800-MEDICARE, TTY users call 1-877-486-2048, 24 hours a day, 7 days a week, to get information on all of your options. CMS requires this type of disclosure when third-party materials market only a subset of plans.

Participating sales agencies may represent Medicare Advantage HMO, PPO, PFFS, stand-alone Prescription Drug Plan, and other Medicare organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

This website is an invitation to request information about Medicare plan options, including Medicare Advantage, Medicare Supplement, and Part D prescription drug plans. By submitting your information through this website, Facebook, or related forms, you give permission for a licensed insurance agent to contact you with information about Medicare plan options, costs, coverage, and enrollment.

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