Regardless of whether you selected a Medicare Advantage Plan, Original Medicare or Original Medicare with a Medicare Supplement, everyone needs prescription drug coverage at some point in life. If you don't use medications it can be very tempting to overlook prescription drug plans altogether but doing so can actually lead to Late Enrollment Penalties later on if you are without "Creditable Prescription Drug Coverage" for 63 or more consecutive days.
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For many individuals who enroll in a MAPD plans (Medicare Advantage Prescription Drug) the drug coverage is included but there are also MA only plans that do not include drug coverage. Individuals can only be enrolled in either one Medicare Advantage plan or one prescription drug plan at a time. If someone enrolls in either it will automatically cancel the other.
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Premium costs and drug formularies will vary greatly depending on the carrier and zip code. Drug costs will also vary depending on the drug stage. On average prescription drug plans are very affordable and when they are finally needed they can save your family thousands of dollars compared to the small cost of maintaining the drug coverage itself.
Prescription Drug Plans
THREE DRUG STAGES (2025)
Beginning in 2025, Drug plans will be capping the annual out of pocket max at $2,000
(Part B drugs excluded) and eliminating the coverage gap phase (aka donut hole).
This means that after reaching that amount out of pocket, beneficiaries total drug costs the remainder of the year will be $0.
Beneficiaries will also be allowed to spread out prescription drug costs throughout the year. This new payment option can help ease the financial pressure of beneficiaries having to pay large amounts out of pocket all at once for more expensive medications. Payment plans won't reduce drug costs but can help with seniors struggling with budgeting these costly medications. ​
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STAGE 1- DEDUCTIBLE STAGE
-Some plans require you to pay an annual deductible
before your plan starts to pay out toward your drug costs.
-Deductible may vary by Drug Plan.
-No plan may exceed $590 in 2025.
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STAGE 2- INITIAL COVERAGE STAGE
You pay the agreed upon coinsurance for your plan.
Example: If you have a plan with a 25% coinsurance provision and your
medication costs $100,you would pay $25 and they would pay $75.
If you and your insurance together paid out $2,000 on prescription drugs, you would enter the last stage, also known as Catastrophic Coverage.​​
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STAGE 3- CATASTROPHIC COVERAGE
Once you reach the Catastrophic stage you will only be responsible for a small amount of coinsurance/copays for your covered medications
After the end of the year, the stages reset and you go back to stage 1