According to the Kaiser Family Foundation, approximately 58 percent of Medicare enrollees receive their prescription medication coverage from a Part D plan. In comparison, the remaining 42 percent obtain their drug coverage via an Advantage (Part C) plan.
In this article, the IHS Insurance Group team takes a look at some of the top Medicare Part D insurance carriers in the nation. It outlines some brief—but relevant—information about them, including their background, the coverage provided under their plans, and what you might expect to pay.
Before diving in, though, let’s begin with a few basics to help ensure that everyone’s on the same page.
Medicare Part D Basics
If you’re eligible for Medicare, you can obtain coverage for prescription medications via one of three ways: 1) through Medicare stand alone Part D, which is provided by the federal government, 2) as part of an Advantage (Part C) plan, or 3) you may get your credible prescription coverage through tour private health insurance you obtain through your employer plan.
In addition to prescription drugs and all of the other basics provided by Original Medicare, Advantage plans also commonly include coverage for extra services like vision, hearing, and/or dental, depending on the specific carrier and plan you choose.
Related: How Medicare Works
Another big difference is that each company will have a different formulary or a list of medications—brand name and generic—for which they provide coverage. As with any other kind of insurance, you can purchase medications not listed on a plan’s formulary, although you might have to pay full price, compared to just your copayment or coinsurance for covered drugs.
IHS Pro Tip: Whether referencing Medicare or third-party insurance carriers, drug formularies typically change from year-to-year as therapies are updated, new ones become available, or further information surfaces. If your specific drug isn’t available or becomes unavailable, your provider may offer a similar—covered—replacement (when recommended by your doctor, of course).
Do you have a Medigap supplement in place? Another important consideration is that according to Medicare.gov:
“Medigap policies can no longer be sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.”
Related: TX Medicare Supplement Comparison
Finally, Advantage plan services are delivered via Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-For-Services (PFFS). Which of these is right for you?
The bottom line is that there’s no right or wrong answer that will apply in every instance. But, in general, HMOs are more restrictive than PPOS, since HMOs require that you visit doctors inside their network, and will not pay for services obtained from specialists outside their network.
Comparatively, PPOs allow you to visit any provider, whether in or out of network. Granted, you’ll pay a higher copayment or coinsurance, but you still won’t be left footing the entire bill.
With these details in mind, here are IHS Insurance Group’s top three Part D carriers, in no particular order.
Based out of Hartford, CT, Aetna provides a wide variety of health insurance plans for medical, pharmacy, dental, behavioral health, and Medicare and Medicaid services.
As of 2018, Aetna had more than 22 million medical members, 12 million dental members, and 13+ million pharmacy benefit management services. Within the company’s network, they have access to 1.2 million healthcare professionals, 700,000+ primary care doctors, and specialists, and more than 5,700 hospitals.
According to Michael Steele, IHS Insurance Group’s prinicipal owner, “Aetna has rolled out some of the most comprehensive and competitive PPO Medicare Advantage plans on the market, in most states. These plans include up to $2,000 of first-dollar dental and vision coverage, in addition to hospital and medical.”
Michael points out that another important consideration is Aetna’s formulary under Medicare part D, which is included with the Advantage plan. “Most Tier I and Tier II generic medications are free, or cost a negligible copayment,” he explains, whereas “most name brand Tier III and IV medications are covered under a reasonable copay, leaving you with a small percentage to pay in relation to the full cost of these drugs.”
Using sophisticated software, the licensed agents at IHS can evaluate all of the Medicare Advantage plans in your county, and then zero in on the most cost-effective option that takes into account your total drug spend for the calendar year. “This number is important to consider when factoring your total expenditures, as many Tier III and IV medications can add up to a large amount over time,” he points out.
Aetna’s Part D Plans & Premiums
Aetna currently offers two standalone prescription drug plans (PDPs), which help cover your medications but do not provide coverage for medical services.
Aetna’s SilverScript Choice PDP offers no deductibles on Tier 1 or 2 drugs, and only a $1 retail copay on Tier 2 medications, for an average monthly premium of between $21 and $58.
Comparatively, Aetna’s SilverScript Plus PDP adds Tier 2 gap coverage and also reduces your annual deductible to $0 for all tiers. This increases the average monthly premium to between $57 and $101.
Founded in 1961, Humana, a health insurance company based in Louisville, KY, is the third-largest in the US, with nearly 17 million members and more than $64 billion in revenue, as of 2018. The company doesn’t provide any publicly available numbers about the size of their network, including healthcare professionals, primary care doctors, specialists, or hospitals.
Humana’s Part D Plans & Premiums
Compared to Aetna, Humana offers a broader range of Part D plans. So, instead of spelling out the differences line-by-line, we’ve condensed everything into an easy-to-read table below (note: we used 77375 as our zip code for quoting purposes):
|Humana Part D Comparison|
|Plan||Walmart Value Rx Plan||Basic Rx Plan||Premier Rx Plan|
|Tier 1/2 Initial Deductible||$1/$4 copay||$0/$1 copay||$1/$4 copay|
|Tier 3/4/5 Initial Deductible||100% until deductible is met||25%/37%/25% coinsurance||$42 copay/44% coinsurance/25% coinsurance|
|Gap||25% for brand name and generic drugs until $6,350||25% for brand name and generic drugs until $6,350||25% for brand name and generic drugs until $6,350|
|Catastrophic?||5% of cost or $3.60 generic copay||5% of cost or $3.60 generic copay||5% of cost or $3.60 generic copay|
For more details, be sure to read through Humana’s Drug List to ensure that your medications are covered.
Formed in 1982 and with two headquarters: one in Bloomfield, CT and the other Philadelphia, PA, Cigna is a large insurance company that boasts nearly 74,000 employees and had a revenue of more than 153 billion, as of 2019.
When it comes to Cigna’s prescription drug plans (PDPs), specifically, they often feature low copays and out-of-pocket costs when utilizing the services of the vast (63,000+) network of preferred pharmacies. Furthermore, they provide access to a formulary consisting of more than 3,000+ covered medications.
Cigna’s Part D Plans & Premiums
Cigna currently offers three different standalone prescription drug plans. Here’s a quick overview of the coverage they provide, along with their estimated costs:
|Cigna Part D Comparison|
|Plan||HealthSpring Rx Secure||HealthSpring Rx Secure-Essential||HealthSpring Rx Secure-Extra|
|Tier 1/2 Initial Deductible||$0–$18||$0–$20||$0–$20|
|Tier 3/4/5 Initial Deductible||$0–$84; 25%–36%||18%–48%||$2–$141; 31%–50%|
|Annual Pharmacy Deductible||$435||$435||$100|
How does each of these popular Part D insurance carriers compare?
Popular Medicare Part D Insurance Carrier Comparison
We’ve covered a lot of information in a relatively small space here, so let’s quickly pull together many of the high-level details discussed above into an easy-to-read table.
|Popular Plan D Comparisons|
|Aetna||$21–$101||Minimal Tier 1/2 deductibles, low retail copays, SilverScript Plus adds gap coverage|
|Humana||$13.20–$58.60||Minimal Tier 1/2 deductibles, 25% gap coverage, some catastrophic coverage, variable Tier 3/4/5 deductibles|
|Cigna||$21.70–$55.30||Minimal Tier 1/2 deductibles (as low as $0), HealthSpring Rx Secure-Extra provides as little as $100 annual pharmacy deductible|
Do you have additional questions about Medicare Part D insurance carriers? What about concerns over which options are best for your needs, your coverage requirements, and your wallet? Let’s wrap everything up next.
Where Can You Learn More About Popular Medicare Part D Insurance Carriers?
Before Medicare implemented Part D in 2006, many beneficiaries were left to pay for their required medications out of their own pockets—or forego them altogether, if they weren’t affordable.
The good—and bad—news is that as a Medicare recipient in 2020, you have many different Part D plans from a wide variety of insurance carriers to select from. That’s where the professionals at IHS Insurance Group can help.
We have more than a decade of experience helping clients like you select the Medicare coverage you need, at prices you can afford, whether Original Medicare, an Advantage (Part C) plan or a standalone prescription drug plan. Contact us today to learn more about how we can help!
In the meantime, if you’d like to instantly view up to 15 competitive carriers, review coverage details, and compare rates before speaking with one of our licensed agents, please click this link and be directed to our online quoting portal.
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