Medicare Part D Drug Plans Explained

What to Know About Part D Drug Plans

Original Medicare does not cover prescriptions you get at the pharmacy. To obtain drug coverage with Medicare, you must enroll in a Part D standalone drug plan (paired with a Supplement/Medigap Plan) or a Part C Medicare Advantage-Prescription Drug Plan (MAPD). When choosing the right drug plan for yourself, you should take into account your personal list of prescriptions and the pharmacy you prefer to use. Each plan has its own formulary (list of covered drugs) and preferred pharmacies (pharmacies they contract with to offer you lower copays). The formulary states how they tier each medicine they cover which determines the drug's cost to you.

We use the government website Medicare.gov's Plan Finder Tool to compare your drug costs when making plan recommendations. This is because there are many plans with different premiums, copays, formularies and preferred pharmacies. The Plan Finder Tool calculates the cost of drugs entered for every plan in your area. When you create your personal www.medicare.gov. account, it makes it easier for you and us to predict your drug costs and plan accordingly. At Imagine Insurance Advisors, we recertify annually with each company so that we understand their plans, benefit packages and pharmacy restrictions.

Part D Drug Plan Coverage Explained

Beginning 2025, after you meet your plan's drug deductible (if your plan has one), you will then pay a copay (or co-insurance) for your medicines at the pharmacy counter. If your out-of-pocket cost for covered prescriptions reaches $2,000, then you have met your maximum-out-of-pocket for the calendar year and your covered prescriptions are $0 for the rest of the year. Everything resets January 1st.

The Medicare Prescription Payment Plan (M3P) provides a way for Medicare beneficiaries to chop their prescription costs up into a monthly amount that is easier to manage and budget. When you opt-in to the Payment Plan, you don't pay for your prescriptions at the pharmacy counter anymore. Instead, your drug insurance carrier will spread the amount over the remainder of the calendar year and bill you monthly. For many with expensive medicines, the first part of the year brings very high up-front prescription bills. By using the M3P, you can avoid the requirement to pay it in such a short time frame. You can opt-in to the Program at any time by calling your insurance carrier.

Assistance for People with Limited Financial Resources

Individuals with income and assets below certain amounts set by the government can apply to Social Security for help with their out-of-pocket prescription costs. You can apply by calling Social Security at 1-800-772-1213 or online at www.ssa.gov. Low Income Subsidy/Extra Help reduces your drug plan premium and copays at the pharmacy counter. Imagine Insurance Advisors can help you apply. See our FAQ for more information.

Plan Change Time – Annual Enrollment Period

After you make your initial Part D plan selection, you can only change your plan during the Annual Enrollment Period (AEP) which goes from October 15th to December 7th for a January 1st effective date. Unless you qualify for a Special Enrollment Period, such as moving out of the service area, receive Extra Help, or are a nursing home resident. This means that you must stay in the plan you chose for the entire calendar year.

There can be many nuances that go into selecting an appropriate Part D drug plan for yourself. Not all these factors are visible at face value; don't make this decision alone. If you are new to Medicare, contact an Imagine agent today to make sure you make the right drug coverage choice for yourself. If you are already on Medicare and your drug coverage needs have evolved overtime, we are more than happy to talk with you during October/November to find a Part D plan that meets your current and anticipated needs for the following year. We have developed a Plan Finder Tool Guide that will assist you in evaluating your drug coverage. We can provide this complementary guide to you upon your request. We feel you should have the knowledge to evaluate your coverage on your own if you wish.

Complimentary, No Obligation Part D Reviews and Recommendations from A Professional

Agents at Imagine Insurance Advisors look forward to assisting you with selecting an appropriate Part D drug plan for the first time or to re-evaluate your plan for the coming year.

To make an appropriate recommendation, we will request a list of your prescriptions, preferred pharmacy and documented permission to discuss plans, as required by Center of Medicare and Medicaid Services (CMS). We use the information you provide to us only to make plan recommendations. You can download and print these forms from our contact page found in the section titled Required Forms for All Medicare Related Appointments.

Top