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Medicare Prescription Plans: What You Need to Know!

Woman with glasses holding prescription bottle

Important details about different prescription plans

There are three major factors you should think about when deciding on your Medicare Part D Drug Coverage.  These are Cost, Coverage and Enrollment Penalties.  Each factor has important points to consider.   These factors will impact how you decide to get your coverage.


The first thing to look at in both these avenues is the costs involved.  Medicare pays some of the drug costs and you pay some as well in both these situations.  .  Look at your current prescription plan and evaluate the following Cost components of any new plans you are considering.

  • Monthly Premium

Most drug plans charge a monthly fee.  You would pay this addition to the Medicare Part B premium.  If you have a Medicare Advantage plan the monthly premium you pay for the coverage will include a part for your drug coverage.

  • The Yearly Deductible  

Some stand-alone drug plans have a yearly deductible which you must meet first.  After you meet this deductible  your insurance starts to pay its share for covered drugs.  Some plans don’t have deductibles.  In those cases the monthly premiums are usually a little higher.

  • Co-payment/Co-insurance

This is the amount you pay after you have met your deductible (if you have one). Most insurance companies have varying levels of co-payment/co-ninsurance based on whether you use generic or brand drugs.  Generics copays are generally lower.  Coinsurance means you pay a percentage(like 25%)  of the cost if the drug.  A Copayment means you pay a certain amount, like $10 for example for all the drugs in a certain tier.


The quality of coverage and amount of savings that you will receive from your Part D Prescription Plan is directly related to the medications that you are taking! Each Part D Prescription drug plan will pay different amounts on the drugs you are taking.  So, the plan your neighbor has may be the best fit for him, but terribly expensive for you! Not only this, but each plan will change the amount they pay on a drug each year.  For example, if your plan covered 100% of your high blood pressure medication this year, it may potentially only cover 60% next year.

For these reasons it is crucial to consult with a licensed agent every year to evaluate your prescription drug plan options.  You are only able to change your plan during open enrollment, so if you would like to schedule a prescription drug coverage evaluation call today and schedule in advance!

Other important coverage facts:

  • The Coverage Gap “Donut Hole”

There is a temporary limit on what drug plans will pay for drugs.  The Donut Hole begins after you and your insurance company have reached this level.  When you reach the “Donut Hole”  the amount you pay for the rx increases.  Not everyone reaches the Donut Hole.  Your premium, non-covered drugs and anything paid for by other insurance can not be applied to you getting out of the gap. The good news is that in addition to the discount on covered brand name prescriptions, your coverage for drugs while in the Gap or Donut Hole will be increasing each year till the gap closes in 2020.

  • Catastrophic Coverage

Once you get out of the gap you automatically get “Catastrophic Coverage.”  This means you only pay a small coinsurance or co-payment for covered drugs for the rest of the year.


If you don’t enroll in a Medicare drug plan when you are first eligible for Medicare and you don’t get extra help or have credible prescription coverage, you will be penalized when you do enroll.  Credible coverage is coverage from an employer or union that at least meets the standards of Medicare prescription coverage.  If you’re subject to the penalty you will have to pay it for every month that you enroll for Medicare Drug coverage.

Open Enrollment is from October 15 through December 7th!! So, contact us now and schedule your free prescription drug plan evaluation in advance!

You can call us at (281) 255-4444 or toll free 1-866-341-8542.

Our licensed Medicare coverage specialists would love to help you in whatever way possible!  

E. Steele

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