Prescription Drug (Part D)- selecting a plan


Prescription Drug Coverage

  Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary).
Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less than a drug in a higher tier.


Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary  
  • Whether you get Extra Help paying your Medicare Part D costs

How to select a Prescription Drug Plan

To get the best Part D Prescription Drug Plan that works for you, your drug list should be assessed to see how each available drug plan that is offered in your residential area tiers each drug in its formulary. 

Drug plans run for a calendar year and you are locked into that plan for a full year unless you have a special circumstance such as moving out of the area or a plan notifies you that they will be no longer be available in your residential area.

Open enrollment for selecting a different drug plan runs from October 15 to December 7 each year.  New plan start dates begin January 1 of each year.  If you do not select a new plan, the one you are enrolled in continues for another year.

   (Contact Key Options for a consultation)

Financial Assistance for Prescription Drugs

 If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. 

In 2019, costs are no more than $3.40 for each generic/$8.50 for each brand-name covered drug.

Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 

In 2018, you may qualify if you have up to $18,210 in yearly income ($24,690 for a married couple) and up to $14,100 in resources ($28,150 for a married couple).

If you don't qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.

Countable resources include:

  • Money in a checking or savings account
  • Stocks
  • Bonds

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