Part D Drug Plans

The Part D prescription drug coverage is a must for all seniors.

Although you are not required to sign up for Part D there are penalties for not doing so. Those penalties are 1% of the national average of all drug plans. This may not sound like much, but you should consider that the penalty will be added on to the monthly premium of any plan you get in the future FOREVER. Also, you might not be able to sign up for Part D at the time you need it. In general, you can only sign up during the Annual Enrollment Period unless you qualify for an exception.

At Health Plan Advisors we will analyze your prescriptions to find the most cost effective plan for your situation. Any particular medication can be on one of several different "tier levels" with each company. Our analysis has saved our clients thousands of dollars.

Below is a simplified explanation of Medicare Drug coverage. Contact us for more details.

Updated for 2017

Medicare Guidelines permit a yearly deductible of $400 ($360 in 2016).

You then go into the "initial coverage period" and will pay approximately 25% for your medications.

When both you and the insurance company has paid $3,700 ($3,310 in 2016) you go into the Coverage Gap, aka "donut hole", with most plans. While in the "donut hole" you pay 51% (58% in 2016) for your generic drugs and 40% (45% in 2016) for your brand name drugs.

After your out of pocket costs have reached $4,950 ($4850 in 2016) you go into "catastrophic coverage" and will pay the greater of 5% of the cost or $3.30 (generics) or $8.25 (brand).

As part of the Affordable Care Act the "donut hole" will close by the year 2020.