Medicare Part D
Answers to commonly asked questions
Making the move to a Medicare Part D prescription drug plan can be easy when you know what to look for in a plan and how to get the most value for your Medicare dollar. Here are simple answers to some of the questions you may have about Medicare Part D to help you make an informed decision.
- What is Medicare Part D?
- Do all plans cover all medications?
- Do plans with lowest premiums offer the best value?
- What do I need to know about the Coverage Gap?
- How can I lower my monthly drug costs to delay reaching the Coverage Gap?
- What are Medicare Star Ratings?
- How can I help ensure uninterrupted home delivery service for my current prescriptions?
Q: What is Medicare Part D?
A: Medicare prescription drug coverage is insurance that covers both brand-name and generic drugs at participating pharmacies. Everyone with Medicare is eligible for this coverage. Even if you don’t take a lot of medications, it’s a good idea to join a Part D plan to protect against rising drug costs during the year.
Q: Do all plans cover all medications?
A: Each plan covers a list of medications (called a formulary) that includes brand-name and generic drugs. Before you choose a plan, make sure the formulary includes the drugs you take now. If a plan doesn’t cover all your medications, there may be alternative drugs on the formulary that you and your doctor can consider.
Q: Do plans with the lowest premium offer the best value?
A: Just because a plan has a low monthly premium doesn’t mean it offers the most value for your specific medication needs. Be sure to consider the full cost of a plan, including the annual costs for all your medications in addition to the monthly premium, to find the plan that provides the best value for you.
Q: What do I need to know about the Coverage Gap?
A: The Coverage Gap, also known as the “Donut Hole,” begins when your total drug costs (the amount that both you and your plan pay) exceed $2,960. It’s important to note that not everyone will enter the Coverage Gap. If you do reach the gap, you will be responsible for 45% of covered brand drug costs* and 65% of generic drug costs under the standard 2015 Medicare benefit. You will remain in the gap until your yearly out-of-pocket costs reach $4,700.
Q: How can I lower my monthly drug costs to delay reaching the Coverage Gap?
A: You can lower your costs by using generic drugs whenever possible. Also, look for a plan that offers even greater savings when you use its home delivery pharmacy service and generic drugs.
Q: What are Medicare Star Ratings?
A: Each year, Medicare rates how well plans perform in different categories, such as member satisfaction. Star Ratings range from 1 Star (poor) to 5 Stars (excellent). Look for a plan with above-average ratings to help ensure you get the high level of quality and service you deserve.
Q: How can I help ensure uninterrupted home delivery service for my current prescriptions?
A: By enrolling in a Part D plan with an Express Scripts home delivery pharmacy in its network, you’ll continue to have access to the pharmacy services you already know. To help avoid having a gap in your coverage, it’s also important to enroll in a plan before your current coverage ends.
* Available from manufacturers that agreed to pay a 50% discount on the negotiated price, excluding the dispensing fee and any vaccine administration fees. The plan pays 5%.