What is covered by Medicare Part D plans varies from state to state and from insurance company to insurance company. Most insurance companies have several types of Part D coverage. The best way to choose a Medicare Part D plan is to look at the premiums and coverage, and find one that meets your needs.
Monthly Premium
The first thing to look at is the premium charged for the Medicare Part D coverage. Different plans require the payment of a different monthly premium. Although premium price is not the only thing you should look at, selecting a premium you can afford is an important part of comparing Medicare Part D plans. Lower premiums usually result in lesser benefits, such as high deductibles.
Deductible
The deductible is the amount you must spend before the insurance company will begin paying benefits. Some plans have no deductible, meaning that the insurance will immediately begin paying benefits. If a plan has a $295 deductible, you must pay the first $295 in drug costs each year before the insurance company will begin paying for your drugs.
Coverage Gap
Most Part D plans have a maximum benefit they will pay in a year. You are responsible for anything over and above this level until you reach the point where catastrophic coverage kicks in. This is called the "coverage gap," or "donut hole." Some plans do not offer coverage after the maximum benefit has been paid. Other plans offer some coverage for some generic drugs, and still others fully cover generic drugs over and above the maximum coverage.
Benefit Types Available
There are two types of Medicare Part D benefits: basic and enhanced. The difference is in the structure of cost sharing. Enhanced benefit plans generally pay a higher percentage of drug costs than basic benefit plans.
Low-income Subsidies
Some states offer low-income subsidies for those who need help paying their Medicare Part D premiums, deductibles and copayments. In states where they are offered, subsidies are available for part or all of the cost of qualifying plans. However, not all plans qualify for low-income subsidies.
Other Considerations
Not all Part D plans cover all drugs. It is important to check with the insurer to confirm coverage of your existing prescriptions. Also, not all pharmacies accept all Medicare Part D plans. Check with your pharmacy to make sure it will accept the plan you are considering.
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