Medicare Part D Plans in Idaho

We found 22 Medicare Part D Plans in Idaho.

The Four Phases of Every Idaho Medicare Part D Plan

Medicare prescription drug plansMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... are designed to help Medicare beneficiaries pay for their prescription drugs. Some of the cost-sharing concepts of these plans are foreign to new Medicare beneficiaries, so let's look at the four phases.

Phase 1 is the Deductible

The deductible is the amount that you pay before your Medicare Part D plan begins paying its share of the costs. So, if you enroll in a 2022 prescription drug plan with a $480 deductible, you'll spend $480 out-of-pocket before cost-sharing coverage begins. Most Medicare Part D plans have a deductible, but some Medicare Part D plans exclude Tier 1 drugs from the deductible, giving immediate coverage on most generic medications.

The Initial Coverage Limit is the Second Phase

The Part D ICL (Initial Coverage Limit) for 2022 is $4.430. During the ICL phase, your Part D plan will cover the majority of your prescription costs. If your prescription costs exceed $4,430 you go into the coverage gap phase ("donut hole")

The Coverage Gap is the Third Phase

After your 2022 gross drug costs have reached $4,330, you will enter the Coverage GapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. phase. This is where you will pay 25% of your medication's retail cost. While the price of generic drugsA generic drug is a prescription medication that has the same active ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. might not be much different, what you pay for brand-name drugs will be higher (because you're paying 25% of the full price). This will continue until you reach $7,050 in True Out Of Pocket Costs (TrOOP).

Some plans offer additional gap coverage, so look for it on the plan information pages.

Phase 4 is Catastrophic Coverage

Once you've spent $7,050 out-of-pocket in 2022 you are out of the coverage gap phase and will receive catastrophic coverage. This happens automatically and ensures that you only pay a small amount for all covered drugs for the remainder of the year.

The out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. that help you get catastrophic coverage include:

1. Your plan's deductible;
2. What you paid during the initial coverage limitOnce you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut... period;
3. Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
4. The amount paid by others, including family members, most charities, and other persons on your behalf; and
5. The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.

Choose Your Part D Plan with Care

Don't make a decision on your choice of Part D Medicare plans based on the premium and deductible alone. It's critical that you verify that your medications are covered. You find this information, and the co-payment tiers, in the formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. On each PDP page (above) we post links to the formulary and pharmacy web pages, and the phone numbers to contact the plan.

CRITICAL: The best Medicare Part D Plans for you can only be determined by factoring in what you can afford, your regular prescriptions, and your health. A bit of time spent on research will pay off in the long run.

Get Your Prescriptions and More with a Medicare Advantage Plan

There's more than one way to get prescription drug coverage with your Medicare benefits. The first way is by enrolling in one of the Medicare prescription drug plans available in Idaho. The second way is to get prescription coverage through one of the many Idaho Medicare Advantage Plans that include Part D benefits. Most Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). available in Idaho include Part D as an additional benefit.

Using Medicare Supplemental Insurance with Part D

With Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. you are responsible for paying about 20 percent of all hospital and medical bills. Without additional protection, even a brief hospital stay can cost you thousands out-of-pocket. That's why we maintain a complete directory of Idaho Medicare Supplement Insurance, also known as Medigap. We make it easy to find the best rates on the coverage you want. All Medicare supplementsMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. sold in Idaho plans are 100% compatible with Medicare Part D plans.

Idaho Medicaid and Your Medicare Part D

If you meet the requirements for both Medicare and Medicaid (aka, "dual eligible" or "Medi-Medi") in Idaho, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra Help, the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. now, call your local Medicaid office for assistance with your dual eligible benefits.

Citations & References

1. Medicare.gov, "Drug coverage (part D)", Last Accessed May 21, 2022
2. Medicare.gov, "How Part D works with other insurance", Last Accessed May 14, 2022
3. Medicare.gov, "Costs for Medicare drug coverage", Last Accessed June 3, 2022
4. Medicare.gov, "Are prescription drugs covered in Medicare Advantage plans?", Last Accessed June 6, 2022
5. SSA.gov, "Extra Help with Medicare Prescription Drug Plan Costs", Last Accessed June 1, 2022
6. CMS.gov, "Landscape Source Files", Last Accessed October 26, 2021
7. CMS.gov, "Medicare Part C & D Performance", Last Accessed October 15, 2021

This Medicare Part D plan state information page was last updated on June 28, 2022.