Prescription Drug Plans For Seniors

Reviewed and Updated by Anastasia Iliou,

You may have noticed by now that Original Medicare (Parts A and B) does not include prescription drugs. Even though it isn’t included in your initial plan, you will encounter penalty fees if you do not purchase a prescription drug plan during your initial eligibility period (up to three months before and after your 65th birthday).

There are a couple of ways for you to get the prescription drug coverage that you need.

How To Get A Drug Plan

Medicare Advantage plans encompass Original Medicare (parts A and B) and additional coverage for costs such as dental care and prescription drugs.

Note: Even though Medicare Advantage includes supplemental pieces, it is not the same thing as Medicare Supplements.

If you have Original Medicare, you can also get your prescription drug coverage with a Part D-only plan. Prescription drug plans, or PDPs, can also be purchased as an addition to an MSA (Medicare Savings Account), or PFFS (private-fee-for-service) plan.

What’s Covered?

Each individual plan will have a formulary, or a list of all the prescription drugs that are covered. The list is often divided into tiers according to cost. Keep in mind that your out-of-pocket drug costs will vary according to the plan you choose, whether or not your pharmacy is in your network, and whether or not you are eligible for Medicare Extra Help. Costs will also depend on your premium, deductible ($400 max in 2017), copayments, and coinsurance.

What’s The Donut Hole?

The donut hole is a limit on what your prescription drug plan will cover. It applies to all Medicare clients who don’t have Extra Help. In 2019, the donut hole limit is $3,820.

In 2020, the donut hole will be going away.

You will pay for 100% of your drug costs until you hit your deductible, $435 in 2020. Once you spend your deductible, you will have coverage based on your chosen plan. Once you’ve spent $4,020, you’ll be responsible for up to 25% of your brand-name drug costs and up to 25% of your generic drug costs.

Click here for a more in-depth look at tips for saving money on prescription drugs.

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