Guide to 2025 Medicare Part D Plans in Pennsylvania
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As you navigate your Medicare Part D plan options in Pennsylvania, it's essential to understand the various plans available and how they can help cover your prescription drug expenses. The average premium in Pennsylvania is $71.53 per month, but you may find plans with premiums as low as $0.00. With 16 plans available, you have plenty of choices to find the coverage that best suits your needs.
In this guide, you'll find everything you need to make an informed decision, from understanding what Medicare Part D covers to tips on selecting the best plan for your needs. Don’t forget to check out our Medicare Part D Plan Guide for more detailed information.
Pennsylvania Medicare Part D Plans
| Plan Name | Premium | Deductible | Rating |
|---|---|---|---|
| AARP Medicare Rx Preferred from UHC | $103.50 | $0 | |
| AARP Medicare Rx Saver from UHC | $64.00 | $590 | |
| Blue Rx PDP Complete | $168.20 | $0 | |
| Blue Rx PDP Plus | $143.20 | $590 | |
| Cigna Healthcare Assurance Rx | $64.40 | $590 | |
| Cigna Healthcare Extra Rx | $95.30 | $175 | |
| Cigna Healthcare Saver Rx | $12.60 | $590 | |
| Clear Spring Health Premier Rx | $73.20 | $590 | |
| Clear Spring Health Value Rx | $8.20 | $590 | |
| Humana Basic Rx Plan | $70.60 | $590 | |
| Humana Premier Rx Plan | $128.90 | $0 | |
| Humana Value Rx Plan | $39.80 | $573 | |
| SilverScript Choice | $44.90 | $590 | |
| Wellcare Classic | $20.30 | $590 | |
| Wellcare Medicare Rx Value Plus | $107.40 | $590 | |
| Wellcare Value Script | $0.00 | $590 |
What You Should Know About Medicare Part D Plans
Medicare Part D plans, offered by private insurance companies, provide coverage for a wide range of prescription medications. These plans are required to cover drugs in all major categories, though your specific medication might not be included. It's essential to review each plan’s formulary, where medications are categorized into tiers that affect their pricing.
While Part D offers broad coverage, it generally excludes medications administered in your doctor’s office or as an inpatient—those are covered by Medicare Part B. The price you pay for your medications can vary depending on which phase of coverage you are in, such as the deductible phase or the initial coverage phase.
Part D plans often feature preferred pharmacy networks that offer better pricing on medications. Confirm that your preferred pharmacy is included in the plan’s network. Additionally, Medicare Part D plans can change their formulary, costs, and other details each year, so it's wise to review your plan annually during the Annual Enrollment Period (AEP) to ensure it remains the best option for you.
What You Need to Know About Medicare Part D Costs and Coverage in Pennsylvania
Breaking Down Part D Costs
Medicare Part D plans include several cost components, such as monthly premiums, annual deductibles, and out-of-pocket expenses. Understanding these costs is key to selecting the right plan for your needs.
Monthly Premiums Explained
The monthly premium for Medicare Part D plans can differ based on the plan and provider. In Pennsylvania, the average premium is $71.53, with some plans available at a lower cost of $0.00. Those with limited income may qualify for premium assistance.
Understanding Deductibles
Deductibles are the initial amount you pay for your medications before your plan begins to cover the costs. In Pennsylvania, the average deductible is $452, though there are 3 plans that do not require a deductible payment.
Copayments and Coinsurance Basics
After reaching your deductible, you’ll pay either a copayment or coinsurance for each prescription. A copayment is a set amount, while coinsurance is a percentage of the drug cost. The specific amount depends on your plan and the medication tier.
Formulary and Drug Tiers
A formulary is a list of medications covered by a Part D plan, and drugs are categorized into tiers with varying costs. Typically, lower-tier drugs are less expensive, so reviewing the formulary of each plan ensures that your prescriptions are covered at an affordable rate.
The Coverage Gap ("Donut Hole")
Good news. As of January 1, 2025, the Medicare Part D coverage gap, also known as the "donut hole," has been phased out.
What Is Catastrophic Coverage?
Catastrophic coverage begins once your out-of-pocket spending hits a specific threshold, ensuring that you pay lower medication costs for the remainder of the year. This phase provides key financial protection for those with high prescription drug expenses.
Low-Income Subsidy (LIS) Assistance
The Low-Income Subsidy (LIS), also known as Extra Help, reduces Medicare Part D costs for eligible individuals. In Pennsylvania, 0 plans provide full LIS benefits, making it easier for low-income beneficiaries to afford their medications.
Choosing the Right Plan for You
Selecting the right Medicare Part D plan requires carefully considering costs and coverage. By comparing premiums, deductibles, and formularies, you can find a plan that meets your healthcare needs and budget.
Steps to Find a Medicare Part D Plan in Pennsylvania
Medicare prescription drug plans work seamlessly with Medicare Parts A and B, all Medigap plans, and Medicare Advantage plans that do not include drug coverage. However, if you have a Medicare Advantage plan that already offers prescription drug benefits, you cannot enroll in a separate Part D plan.
With so many Medicare Part D plans to choose from—16 in Pennsylvania alone—it’s important to weigh several factors to find the right one for your needs. Here’s a guide to help you make an informed choice:
1. Assess the Formulary
Each Part D plan has a formulary that lists the medications it covers. Check the formulary to ensure that your prescriptions are included, and take note of the drug tiers, as they will impact your costs.
2. Compare Premiums and Deductibles
Medicare Part D premiums and deductibles can vary widely. Compare the monthly premium and annual deductible for each plan to determine what fits your budget best. Remember that a plan with a lower premium may have higher out-of-pocket costs, so consider the total cost of your medications.
3. Check Pharmacy Networks
Many plans offer lower costs if you use pharmacies within their preferred network. Verify that your pharmacy is in-network, and consider whether the plan offers convenient mail-order options for your prescriptions.
4. Look for Coverage in the Donut Hole
The "donut hole" is a coverage gap where you may pay more for your medications. Some plans provide additional coverage during this phase, which can be beneficial if you expect to have high drug costs.
5. Evaluate Star Ratings
Medicare rates Part D plans based on quality and performance, with higher star ratings indicating better service. Choosing a plan with a strong star rating can provide peace of mind regarding the quality of coverage and customer service.
6. Explore Low-Income Subsidy (LIS) Plans
If you qualify for the Low-Income Subsidy (LIS), you may be eligible for plans that reduce your costs significantly. These plans can lower your premiums, deductibles, and copayments, making prescription drugs more affordable.
Considering these factors, you can choose a Medicare Part D plan that meets your medication needs and financial situation. Make sure to review your options annually, as plan details can change from year to year.
Creditable Coverage and the Impact of Late Enrollment Penalties
Having creditable coverage means your current prescription drug plan is as good as or better than Medicare Part D. If you have such coverage through an employer, union, or other source, you can delay enrolling in Medicare Part D without facing a late enrollment penalty. However, if you go without creditable coverage for more than 63 days after your Initial Enrollment Period, you may incur a late enrollment penalty when you do enroll.
How to Confirm If Your Coverage Is Creditable
Your insurance provider is required to notify you annually if your coverage is creditable. Keep this notice as proof for when you decide to enroll in Medicare Part D. If you have any doubts, reach out to your provider for confirmation.
Understanding the Late Enrollment Penalty
The late enrollment penalty is calculated as 1% of the national base beneficiary premium for every month you went without creditable coverage. This penalty is added to your Part D premium and continues for as long as you have Medicare drug coverage. To avoid this, ensure you enroll in a Part D plan when your creditable coverage ends.
Understanding the Medicare Part D Enrollment Process
Enrolling in a Medicare Part D plan is a crucial step to ensuring you have the necessary prescription drug coverage. The enrollment process involves specific periods during which you can sign up for or make changes to your plan. Understanding these periods and the steps involved can help you make informed decisions about your coverage.
Initial Enrollment Period (IEP)
Your Initial Enrollment Period is a 7-month window that begins 3 months before your 65th birthday, includes your birth month, and ends 3 months after. This is the time to enroll in Medicare Part D for the first time.
Annual Enrollment Period (AEP)
Each year, from October 15 to December 7, the Annual Enrollment Period allows you to enroll in a new Part D plan, change your current plan, or drop your coverage. Changes made during AEP take effect on January 1 of the next year.
Medicare Advantage Open Enrollment Period (OEP)
From January 1 to March 31, the Medicare Advantage Open Enrollment Period offers you the chance to switch Medicare Advantage plans or return to Original Medicare and sign up for a standalone Part D plan.
Enrolling at the right time is key to ensuring you have the necessary Medicare Part D coverage. For a deeper dive into the various enrollment periods, read our comprehensive Medicare Enrollment Periods guide.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Citations & References
- Medicare.gov, "Your Guide to Medicare Drug Coverage", Last Accessed March 1, 2025
- Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed August 1, 2024
- Medicare.gov, "Costs", Last Accessed July 16, 2024
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed June 7, 2024
- SSA.gov, "Extra Help with Medicare Prescription Drug Plan Costs", Last Accessed March 10, 2025
- CMS.gov, "Landscape Source Files", Last Accessed March 1, 2025
- CMS.gov, "Medicare Part C & D Performance", Last Accessed March 1, 2025