How Do Medicare Prescription Drug Plans Work?

Prescription drug plans for Medicare help pay for prescription drugs that you might need now or in the future. If someone doesn’t currently take prescription drugs, it’s still recommended to consider getting a Medicare drug plan. While Medicare drug coverage is optional, it is typically offered to everyone with Medicare.


People who decide that they shouldn’t get it when they become eligible might have to pay a late enrollment fee for the rest of their Medicare coverage plan’s life, which becomes problematic especially when one doesn’t have any other credible prescription drug plan. Since each plan can vary in specifications and cost, get in touch with us so that our professionals can help you learn more about our prescription drug plans for Medicare.


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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