Prescription drug coverage is an incredibly important part of our health plans. This is especially true for people over age 65 and on Medicare. However, trying to understand Medicare prescription drug coverage can be challenging.<\/p>\n\n\n\n
To help you break through the confusion, Blue KC has put together this summary of how Medicare prescription drug plans work.<\/strong> But before we start talking about the prescription drug components, let\u2019s start with reviewing the basics.<\/strong><\/p>\n\n\n\n There are four parts of Medicare<\/a>, each designated with a letter:<\/p>\n\n\n\n How drug coverage fits into Medicare plans<\/strong><\/p>\n\n\n\n Here\u2019s where it might get a little confusing. The two parts of Medicare that cover prescription drugs are Part C and Part D.<\/p>\n\n\n\n Please note:<\/strong> Medicare Part D prescription plan and Part C (MA) with prescription drugs are two separate types of coverages; you cannot get both.<\/p>\n\n\n\n Which Medicare prescription drug coverage is right for you?<\/strong><\/p>\n\n\n\n It depends. Basically, you have two choices; going with Original Medicare Parts A and B then purchasing Medicare Part D prescription plan separately; or go with a MA plan with prescription coverage already built in.<\/p>\n\n\n\n Let\u2019s take a closer look at the two options:<\/p>\n\n\n\n Medicare Advantage<\/strong> Prescription Drug <\/strong>(MAPD) plans are a type of Medicare Advantage<\/strong><\/a> <\/strong>plan that includes prescription drug coverage. You typically get more coverage than with Original Medicare and you don’t need to worry about a separate Part D plan. Often there are additional extra benefits, such as dental and vision coverage, as well as lower costs \u2013 all making these plans very popular.<\/p>\n\n\n\n Medicare Part D,<\/strong><\/a> also known as Medicare\u2019s prescription drug coverage, helps pay for medications not covered under parts A or B. This stand-alone prescription drug plan is optional and is also sold by private insurance companies. One reason why many choose this option is Part D can work with other insurances<\/a> such as Medicare Supplement also known as Medigap, employer coverage, COBRA, Medicaid, and many others. The deductibles for Medicare Part D also vary by plan but can’t be higher than $545 in 2024.<\/p>\n\n\n\n As you compare plans and look for the right Medicare prescription drug coverage for your needs, you\u2019ll see these words being used quite a bit: copay, coinsurance, and deductibles<\/a>. What exactly do they mean?<\/p>\n\n\n\n Deductible<\/strong> is what you must pay for prescriptions before Original Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your other insurance begins to pay<\/p>\n\n\n\n Perhaps you\u2019ve heard of a coverage gap called the \u201cDonut Hole\u201d when it comes to your prescription drugs?<\/p>\n\n\n\n It means this: You stay in the Initial Coverage Stage for prescription drugs until after you and your drug plan have spent a total of the $5,030<\/strong> on covered drugs.<\/strong> $5,030 is the maximum for 2024. Many people don\u2019t reach this limit. But if you do, you go into the Donut Hole.<\/p>\n\n\n\n Once there, you pay more for covered prescriptions. However, the Medicare Coverage Gap Discount Program<\/a> provides manufacturer discounts on brand name drugs. You pay 25% of the negotiated price and a portion of the dispensing fee for brand name drugs. You also receive some coverage for generic drugs. You pay no more than 25% of the cost for generic drugs and the plan pays the rest. Only the amount you pay counts and moves you through the coverage gap.<\/p>\n\n\n\n\n
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What are copays, coinsurance, and deductibles?<\/h3>\n\n\n\n
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What you need to know about the Medicare Donut Hole<\/h3>\n\n\n\n