Medicare Part D Plans in Pennsylvania

We found the 26 best Medicare Part D Plans in Pennsylvania for 2023.

We also ranked the best Medicare Advantage plans with Part D in Pennsylvania for 2023.

Every Part D Plan in Pennsylvania Has 4 Cost Phases

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

A Medicare Part D plan's deductible is the amount you pay out-of-pocket before the initial coverage phase begins and the plan begins paying its share. So, if you enroll in a plan with a $225 deductible, you'll spend that much at the pharmacy for your prescriptions. After that amount, you will pay the copayA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. amount only until you reach 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.. Most Medicare prescription drug plans have a deductible, however, many plans exclude Tier 1 drugs from the deductible, which gives you first-dollar coverage on most lower-cost medications.

NOTE: The maximum Part D plan deductible in 2023 is $505.

The Initial Coverage Limit is the Second Phase

The 2023 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... (ICL) is $4,660. The ICL phase is when your Part D plan begins to pay the bulk of the costs. If your prescription costs exceed $4,660, you will enter the Coverage Gap phase (aka, "donut hole").

The Coverage Gap is the Third Phase

After your gross drug costs have reached $4,660, you will enter the Coverage Gap 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 $7,400 in True Out Of Pocket Costs (TrOOP).

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

Catastrophic Coverage is the Fourth Phase

After you have spent $7,400 in true out-of-pocket costs on your medications, you get out of the coverage gap phase and you automatically receive "catastrophic coverage". In this phase, you will only have to pay a small percentage of coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  or payment on covered drugs for the rest 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 limit 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

Choose from the available Part D Medicare plans carefully, and don't settle on a Part D plan until you know that your most expensive medications are covered at a price you can afford. This information is available in the plan's 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.. You'll find links to the formulary information, pharmacy information, and the customer service phone number on each PDP page (above).

VITAL: Identifying the best Medicare Part D Plans requires research. What works the best for you is all about your regular prescriptions (if any), your health, and what you can afford.

Did you Know Most Medicare Advantage Plans Include Prescription Benefits?

Your Medicare benefits are flexible, and there's more than one way to get prescription drug coverage. If you want to keep your 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 can enroll in one of the stand-alone prescription drug plans available in Pennsylvania. The other way to get Part D coverage is to enroll in one of the many Medicare Advantage Plans available in Pennsylvania that include Part D benefits.

Combining a Medicare Supplement and Medicare Part D Benefits

With Original Medicare 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 Pennsylvania 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 Pennsylvania plans are 100% compatible with Medicare Part D plans.

Pennsylvania Medicaid and Your Medicare Part D

Pennsylvania beneficiaries who qualify for both Medicare and Medicaid (aka, "dual eligible" or "Medi-Medi") may be enrolled in a Pennsylvania Medicare Prescription Drug Plan automatically, as well as Social Security's Extra Help program. The Extra Help program pays for most of your prescriptions, but only if you meet the strict eligibility requirements. If the dual eligible option does not meet your needs, you have the option to enroll in a Pennsylvania Part D plan that does. If you are already receiving MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States., contact your local Medicaid office for assistance in the transition to Medicare.

Citations & References

1. Medicare.gov, "How to get prescription drug coverage", Last Accessed September 3, 2022
2. Medicare.gov, "How Part D works with other insurance", Last Accessed July 14, 2022
3. Medicare.gov, "Costs for Medicare drug coverage", Last Accessed September 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 18, 2022
7. CMS.gov, "Medicare Part C & D Performance", Last Accessed October 15, 2022

This Medicare Part D plan state information page was last updated on November 8, 2022.