Looking for a place to get started? Here is an overview of the Medicare Part D prescription drug and Medicare Advantage programs: Medicare Part D prescription drug plans (or PDPs) provide insurance coverage for your prescription drugs. Medicare Advantage plans (MAs or MA-PDs) provide your Medicare Part A coverage (In-patient and Hospitalization) and your Medicare Part B coverage (Doctors visits and Out-Patient care) - and maybe even Medicare prescription drug coverage. Medicare Part D plans and Medicare Advantage plans are both voluntary programs and you are not required to join a plan. But you may be subject to a late-enrollment penalty if you decide to join a prescription drug plan sometime after your initial enrollment period has ended. Medicare Part D plans and Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS or Medicare) and implemented by private insurance companies (such as Aetna, Humana, and United HealthCare). If you decide to enroll in a Medicare Part D plan or Medicare Advantage plan, you will find that, like any insurance, you pay a monthly premium. The monthly premiums for a Medicare Part D PDP can range from under $20 to over $130 dollars. The monthly premiums for a Medicare Advantage plan with (MA-PD) or without (MA) prescription coverage can range from $0 (no kidding) to well over $100. Medicare Part D and Medicare Advantage plans may have an initial deductible, co-payments or co-insurance, and some Donut Hole (Doughnut Hole) or Gap coverage (you can find more on these topics in our Glossary). When you enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan that offers prescription coverage, you should find that your prescription medication costs are reduced. The amount of savings depends on the Medicare plan you select. If you wish to learn more, you can click on this link to view all of the Medicare Part D plans in your State
Trying to choose a Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan? Medicare suggests that you look at Coverage, Cost, and Convenience - to these criteria we also add that you should probably consider the Company and your level of Comfort.
Coverage - Are your prescription medications covered by this plan? Are there generic alternatives for your brand-name drugs? Can you work with this plan to get a formulary exception should you need a medication that is not covered on the existing formulary? What price-tiers apply to your medications? What health coverage does the Medicare Advantage plan offer beyond basic Medicare? Are there any additional benefits offered by the plan?
Cost - What are the monthly plan premiums? Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible? What are the co-payments or co-insurance that you pay for your medications or healthcare? What are the plan's coverage limits? Is there any prescription coverage in the Donut Hole?
Convenience - How difficult is it to find a pharmacy or a health care provider? (Note: most national Medicare Part D plans have a pharmacy network of over 50,000 pharmacies.) Are your restricted to any healthcare network? Do your doctors accept this Medicare Advantage plan? How easy is it to work with this Medicare Part D plan or Medicare Advantage plan?
Company - Is the company who provides the Medicare Part D or Medicare Advantage plan important to you? Often people choose a Medicare plan based only the Medicare plan provider's reputation or recommendation.
Comfort - Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan? Would you rather spend a few extra dollars per month because you have an idea how your current Medicare plan operates and your plan costs are predictable?
Still looking for more? Here are some general tips specifically for Medicare Part D prescription drug plan selection.
You can enroll in a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the Annual Open Enrollment Period (or AEP) starting October 15th and continuing for seven weeks through December 7th with your newly selected Medicare plan starting on January 1st of the following year. Please note that if you are just turning 65 or are newly eligible for Medicare, you will be granted a seven (7) month enrollment period when you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month.
The good news about enrollment is that you always pay the same amount for a Medicare D plan or Medicare Advantage plan, no matter where or how you enroll. You can enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 7 to 10 business days you should receive your Medicare Part D new Member information. Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan's Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card. Please note that the Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage Plans begins January 1st and continues through February 14th -- during the MADP members of Medicare Advantage plans can switch back to original Medicare and join a stand-alone Medicare Part D drug plan.
Please also note that you may be eligible for a Special Enrollment Period (SEP) allowing you to change Medicare plans outside of the AEP. Click here to read more about Special Enrollment Periods.
Medicare Part D beneficiaries with an income above a certain level (link to 2015 IRMAA rate charts) have an increase in their monthly Medicare Part D prescription drug plan premiums, based on the implementation of the Medicare Part D Income-Related Monthly Adjustment Amount (IRMAA). The Medicare Part D IRMAA began in January 2011. For the 2015 plan year, the IRMAA will increase slightly.
Please note that IRMAA also affects Medicare Part B premiums.
Our Q1Medicare.com RxSavings Center provides you with many different ways to search through retail drug discount programs. There is no cost to use the RxSavings-Center and you can search alphabetical by drug name or search by using the retailer's drug category or you can search by using the RxSavings-Finder - a combination of drug categories and discount drug programs. You will find that the discount drug information is also cross referenced with several lists of popular medications, including a list of the top 100 Medicare drugs. Links for each medication provide you with more information on drug strengths, form and available quantities - as well as discount drug program pricing, program availability, and program stipulations. You can also search by:
Would you like to learn more about 2016 Medicare Part D Prescription Drug Plans? We have information available for all 2016 Medicare Part D prescription drug plans across the country. We provide a national overview of all Part D plans and state specific summaries of the Medicare Part D prescription drug plans in your area. Here are a few state examples:
Looking for a simpler way to determine which 2015 Medicare Part D prescription drug plans cover a particular medication? Try our prescription drug search tool : PDP-DrugFinder. PDP-DrugFinder is designed for fast, single medication searches and provides plan details, cost-sharing, and average retail drug price, and drug usage management information for your covered medication.
With PDP-DrugFinder, you can search for a medication different ways and find all the Medicare Part D plans in your state that cover your prescription drug or simply determine whether a specific medication is covered by your 2015 Part D prescription drug plan.
Is your particular medication also part of a local retailer’s drug discount program? Check our RxSavings-Finder to see if a lower discount price is available.
Want to browse all medications on your plan’s formulary (list of covered drugs)? Our Formulary Browser shows covered drugs along with their cost-sharing, average retail price and drug usage management.
Medicaid "Spend Down" and Medicare Part D People with Medicare who are also eligible for Medicaid because of high medical expenses can get Medicare prescription drug coverage no matter if they are in the Original Medicare Plan or a Medicare A ...
Looking for the latest information on Medicare Part D prescription drug plans? Then join the thousands of people who receive our Medicare Part D Newsletter. Our free Newsletter is published on a regular basis and provides details on various areas of your prescription drug plan. The Newsletter presents new Medicare developments, frequently asked questions, and sometimes digs into more complex areas of Part D coverage. We also welcome reader input and suggestions for new topics. Complete the form below to sign up for the Newsletter. Please note, that we never share your personal information with other parties.
Low Income Subsidy (LIS) Benchmark and $0 Premium Plans
If you receive the full Extra-Help, full LIS, or are dual eligible for Medicare and Medicaid, there are Medicare Prescription Drug plans in your state the will qualify for the $0 monthly premium. Click below to review our state benchmark premium Blog. You can click on the benchmark premium for your state to review all plans qualifying for the $0 monthly premium.
Each year the Centers for Medicare and Medicaid Services (CMS) publishes basic Medicare Part D benefit parameters that are used as a standard for the design of Medicare Part D plans offered by private Medicare Part D plan providers. Prescription drug plan providers can deviate from the CMS standard defined benefits, but the plans must offer Medicare Part D prescription drug coverage that at least meets the basic CMS standard benefit parameters or values.
In 2016, the CMS basic or standard Medicare Part D plan provides:
2016 standard Initial Deductible: The maximum initial deductible is $360 (up from $320 in 2015). In past years, some Medicare Part D plan providers offered prescription drug plans with an Initial Deductibles that was less than the CMS standard. If your Medicare Part D plan has an initial deductible, you are responsible for 100% of your prescription drug costs while in the initial deductible phase.
Initial Coverage Phase: The 2016 Initial Coverage Limit is $3,310, up from $2,960 in 2016. So after your initial deductible (if any) is met and until your Medicare plan's negotiated retail costs of your medications reaches $3,310, you share the costs for your medications with your plan by paying coinsurance or co-payments. The CMS standard or model coinsurance is 25%.
The 2016 Coverage Gap (also known as the Donut Hole): After you meet your Initial Coverage Limit of $3,310 and until your Total Out-of-Pocket (TrOOP) costs (not including plan premiums) reaches $4,850, you pay 100% of the plan’s negotiated retail price for covered prescriptions (less donut hole discount donut hole discount). Following the CMS standard defined or model Medicare Part D plan, your prescription costs would be $7,515 when you exit the Donut Hole.
Catastrophic Coverage: Once your total out-of-pocket cost (TrOOP or total drug spend) has reached the 2016 Donut Hole or Coverage Gap exit point of $4,850 (this amount does not include your monthly Part D plan premiums), you pay only a maximum of 5% of the retail price for your covered drugs or a
co-payment of $2.95 for covered generics and $7.40 for covered brand-name
drugs, whichever cost is greater.
You can begin to prepare for your 2016 Medicare Part D prescription drug spending now. Millions of Medicare Part D beneficiaries enter the Donut Hole or Coverage Gap each year -- and most people do not exit the Donut Hole, but instead stay in the Donut Hole through the remainder of the year. Would you like to estimate your budget for prescription drug in 2016? Use our free PDP-Planner to plan now for 2016
You can also use our Donut Hole Calculators from prior plan years to compare your previous Coverage Gap experiences with our Donut Hole estimate. You can then adjust the results from our PDP-Planner to better estimate your total 2016 prescription drug costs.
The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.