We found the 24 best Medicare Part D Plans in North Carolina for 2023.
- The average A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. is $50.94 per month, however the lowest premium is just $4.20.
- The average drug plan A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. is $388 per year, but 4 plans have a zero-dollar deductible.
- Medicare rated 0% of all plans available in North Carolina 4 stars or higher.
- There are 9 basic benefit plans and 15 enhanced benefit plans.
- A total of 5 plans offer full Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) for those who qualify.
- There are 5 plans that have additional coverage in the coverage gap phase (aka, "donut hole").
We also ranked the best Medicare Advantage plans with Part D in North Carolina for 2023.
North Carolina Medicare Part D Plans
|Plan Name||Premium||Deductible||Benefit Type||LIS||Gap
|AARP MedicareRx Preferred||$109.50||$0||Enhanced||No||Yes||Yes|
|AARP MedicareRx Saver Plus||$43.60||$505||Basic||No||No||No|
|AARP MedicareRx Walgreens||$28.30||$350||Enhanced||No||No||No|
|Blue Medicare Rx Enhanced||$132.50||$0||Enhanced||No||Yes||No|
|Blue Medicare Rx Standard||$101.50||$475||Basic||No||No||No|
|Cigna Extra Rx||$67.60||$100||Enhanced||No||Yes||Yes|
|Cigna Saver Rx||$12.70||$505||Enhanced||No||No||No|
|Cigna Secure Rx||$34.80||$505||Basic||Yes||No||No|
|Clear Spring Health Premier Rx||$17.50||$505||Enhanced||No||No||No|
|Clear Spring Health Value Rx||$31.50||$505||Basic||Yes||No||No|
|Humana Basic Rx Plan||$38.30||$505||Basic||Yes||No||No|
|Humana Premier Rx Plan||$81.50||$300||Enhanced||No||Yes||Yes|
|Humana Walmart Value Rx Plan||$36.10||$505||Enhanced||No||No||No|
|Mutual of Omaha Rx Essential||$19.90||$505||Enhanced||No||No||No|
|Mutual of Omaha Rx Plus||$78.20||$505||Basic||No||No||No|
|Mutual of Omaha Rx Premier||$63.20||$505||Enhanced||No||No||Yes|
|Wellcare Medicare Rx Value Plus||$71.40||$0||Enhanced||No||No||No|
|Wellcare Value Script||$11.10||$505||Enhanced||No||No||Yes|
North Carolina Medicare Part D Plans Have Four Phases
Part D prescription drug plans help North Carolina's Medicare beneficiaries pay for their prescriptions. If you're new to Medicare, you may not be familiar with how Medicare Part D Out-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. work. So, let's start with the four cost-sharing phases.
The Deductible Phase
The deductible (up to $505 in 2023) 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 2023 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.
Phase 2 is the Initial Coverage Limit
For 2023, the Part D Initial Coverage Limit (ICL) is $4,660. Your Part D plan will pay the bulk of your prescription cost during the ICL phase. If your costs exceed $4,660, then you will be in the coverage gap phase (aka "doughnut hole")
Phase 3 is the Coverage Gap
After your gross drug costs have reached $4,660, you will enter the A 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 A 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 $7,400 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 $7,400 out-of-pocket 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 costs that help you get catastrophic coverage include:
- Your plan's deductible;
- What you paid during the Once 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;
- Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
- The amount paid by others, including family members, most charities, and other persons on your behalf; and
- The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.
The Lowest Premium May Not Be the Lowest Overall Cost
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 A 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.
Medicare Part D is Included in Most Medicare Advantage Plans
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 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... available in North Carolina. The second way is to get prescription coverage through one of the many North Carolina Medicare Advantage Plans that include Part D benefits. Most Medicare 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 North Carolina include Part D as an additional benefit.
Medicare Part D and Medicare Supplements Work Together
Medicare does not pay for all of your hospitalization and medical bills. In fact, Original 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. only covers about 80 percent of your major medical costs. We keep an up-to-date directory of North Carolina Medigap Plans, also called Medicare 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., with the tools you need to find the best price and coverage. Medicare Part D plans are fully compatible with North Carolina Medigap plans.
Medicare Part D for Dual Eligible People in North Carolina
In North Carolina, if you are eligible for both Medicare and Medicaid (aka, "dual eligible" or "Medi-Medi") you will automatically be enrolled in a North Carolina Medicare Prescription Drug Plan and the Social Security Extra Help program. Extra Help pays for most of the costs of your prescriptions if you meet the eligibility requirements. You may also enroll in a plan of your own choosing that better meets your needs. If you qualified for Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. before you were eligible for Medicare, contact your local Medicaid office.
Citations & References
- Medicare.gov, "How Medicare Prescription Drug Coverage Works with a Medicare Advantage Plan or Medicare Cost Plan", Last Accessed September 28, 2022
- Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed August 1, 2022
- Medicare.gov, "Medicare costs at a glance", Last Accessed September 11, 2022
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed June 7, 2022
- SSA.gov, "Extra Help with Medicare Prescription Drug Plan Costs", Last Accessed June 1, 2022
- CMS.gov, "Landscape Source Files", Last Accessed October 18, 2022
- CMS.gov, "Medicare Part C & D Performance", Last Accessed October 15, 2022
This Medicare Part D plan state information page was last updated on .