Stand-Alone Prescription Drug Plans Can Help Reduce Your Costs for Medications
Medicare Part D Prescription Drug Plans (PDP) help people with Medicare afford prescription drugs since Original Medicare doesn’t cover medications. If you have Original Medicare, you may want a PDP to get coverage for your drugs. Medicare Part D plans are sold by private insurance companies, like Florida Blue. Florida Blue offers two stand-alone Medicare Prescription Drug Plans (Part D).
Premier Rx and Complete Rx cover:
Many generic and brand-name drugs with predictable copayments
May include preferred pharmacies for lower cost-sharing
An extensive list of plan-covered drugs (formulary)
May include a low-cost mail-order pharmacy service for free home delivery of your medications
A nationwide pharmacy network
Three Ways to Get Medicare Part D Coverage
Add Part D coverage to your Original Medicare Parts A and B coverage with a stand-alone Medicare Prescription Drug Plan (PDP).
Choose the convenience of a Medicare Advantage Prescription Drug Plan (MAPD) that includes both medical and prescription drug benefits.
Select both a Medicare Supplement Plan and a Medicare Prescription Drug Plan to add to your Original Medicare Parts A and B coverage.
Costs for Medicare Prescription Drug Plan Coverage
What Does a Medicare Part D Plan Cost?
Like Original Medicare, Medicare Prescription Drug (PDP) plans share the cost of care through deductibles, co-payments (copays) and co-insurance.
Your actual PDP costs will vary depending on the plan chosen, prescription drugs you use, whether the drugs you use are on your plan's formulary, and whether you go to an in-network preferred or standard pharmacy.
Different Types of Costs for a Medicare Part D plan:
-
Deductible - The amount you pay before Original Medicare begins to pay its share of the cost.
-
Copay - A flat dollar amount (for example, $10) you pay each time you fill a drug.
-
Coinsurance - A percentage (for example, 10%) you pay for your prescription drugs.
-
Premium - A fixed, monthly amount you pay for your PDP coverage.
2022 Medicare Part D Stages
DEDUCTIBLE STAGE
Patient pays
*varies by plan
*Covered drugs and costs vary from plan to plan
INITIAL COVERAGE
Patient Pays
$4,430
copay/coinsurance varies by plan
↓
when total spend reaches $4,430 enter Coverage Gap
COVERAGE GAP
Patient pays
25% Brands
25% Generic
*varies by plan, some plans may include drug coverage through the gap
↓
When out-of-pocket reaches $7,050 exit Coverage Gap
CATASTROPHIC COVERAGE
Patient pays
5% Brands
5% Generics
Overview of Florida Blue Medicare Prescription Drug Plans
| Features | BlueMedicare Premier Rx (PDP) | Blue Medicare Complete Rx (PDP) |
|---|---|---|
|
Formulary Tiers Covered |
Formulary Tiers 1-5 |
Formulary Tiers 1-5 |
|
Annual Deductible |
$480 (Tiers 3-5) |
$0 |
|
Initial Coverage Stage |
$4,430 |
$4,430 |
|
Catastrophic Stage |
$7,050 |
$7,050 |
|
Nationwide pharmacy network |
||
|
$0 select immunizations and vaccinations |
||
|
At-home delivery service |
Part D Formulary
What is a formulary?
A formulary is the list of drugs, from brand-name to generic, that are covered by a Medicare Prescription Drug Plan. Covered drugs and costs vary from plan to plan.
Many plans have a tiered formulary, where drugs are divided into groups called "tiers" based on their cost.
In general, the lower the formulary tier, the lower the cost to you.
Generic drugs typically are on Tiers 1 and 2.
Part D Formulary Tiers:
| Tier 5 (Specialty) | $ $ $ $ $ |
| Tier 4 (Non-Preferred) | $ $ $ $ |
| Tier 3 (Preferred Brand) | $ $ $ |
| Tier 2 (Generics) | $ $ |
| Tier 1 (Preferred Generics) | $ |
Call a licensed Medicare agent.
Have questions about Medicare Prescription Drug (Part D) plans?
Request a call from a licensed agent.
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