Part D Prescription Drug Plans - Silvertone Med Plans

Enrolling in Part D Prescription coverage is voluntary unless receiving benefits from Medicaid.
If you already have sufficient (creditable) prescription coverage through a group plan or VA benefits then it is not necessary to join a Part D plan.

There are two ways to get Medicare Prescription Drug Coverage.

Stand Alone
Prescription Drug Plans (PDP)

These plans add drug coverage to Original Medicare and are often selected when covered under Medigap plans. PDP’s vary in cost and coverage so it is important to select a plan based on your needs.

Medicare Advantage Plans
including Prescription Drug coverage (MA-PD)

You get all of your Medicare Part A, Part B and Part D coverage bundled in one plan like an HMO or PPO. Prescription plan coverage options are restricted to the medical plan selection.

The following costs are associated with Prescription Drug coverage. Your actual costs will depend on usage and plan selection and whether you qualify for Extra Help paying for your Part D costs:

Monthly
Premium

Most plans charge a monthly premium which you pay in addition to your Medicare Part B premium. If you receive prescription coverage through a MA-PD plan then the monthly premium includes the prescription drug premium.

Annual
Deductible

The amount you pay upfront for prescriptions before coverage begins. Some plans do not have an annual deductible.

Copayments/
Coinsurance

Amounts you pay for your covered prescriptions. Each plan and formulary list has different cost sharing.

Coverage Gap
(Donut Hole)

Most plans have a coverage gap. This means that after you and your insurance company pay out a set amount in total prescription costs for the year ( $4,660 in 2023) than you commence a gap in coverage known as the “donut hole”. In the donut hole you can expect to pay 25% of the total drug cost. Once the members annual out of pocket expenses reach a set maximum then catastrophic coverage commences.

When reviewing PDP plans the major factors affecting monthly premium rates are the deductible and whether any coverage applies in the donut hole.

If you don’t sign up for Prescription Drug coverage when first eligible or have some other creditable coverage you will be charged a late enrollment penalty. In addition you can be penalized anytime you go a period of more than 62 days without creditable coverage. The penalty is calculated by multiplying 1% of the national base premium times the number of months you should have been enrolled but did not.