26 Best Medicare Part D Plans in Pennsylvania for 2023

We found the 26 best Medicare Part D Plans in Pennsylvania for 2023. Sign-up for 2024 Medicare Part D plan notification HERE.

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

Pennsylvania Medicare Part D Plans Have Four Phases

Part D prescription drug plans help Pennsylvania'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 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")

The Third Phase is a Coverage Gap

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 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:

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 Wisely

Evaluate Part D Medicare plans wisely. If you have a regular prescription or two, we suggest that you verify that the plan you want offers your medication(s) at a good price. You find this information in the formulary. We post links to the formulary and pharmacy web pages, as well as the plan's phone number, on each of the PDP pages listed above.

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 prescription drug plans available in Pennsylvania. The second way is to get prescription coverage through one of the many Pennsylvania Medicare Advantage Plans that include Part D benefits. Most Medicare Advantage plans available in Pennsylvania 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 only covers about 80 percent of your major medical costs. We keep an up-to-date directory of Pennsylvania Medigap Plans, also called Medicare Supplements, with the tools you need to find the best price and coverage. Medicare Part D plans are fully compatible with Pennsylvania Medigap plans.

Getting Medicare Part D with Pennsylvania Medicaid

If you meet the requirements for both Medicare and Medicaid (aka, "dual eligible" or "Medi-Medi") in Pennsylvania, 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 Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.

Plans Offered

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.

Citations & References

1. Medicare.gov, "How Medicare Prescription Drug Coverage Works with a Medicare Advantage Plan or Medicare Cost Plan", Last Accessed September 28, 2022
2. Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed August 1, 2022
3. Medicare.gov, "Medicare costs at a glance", Last Accessed September 11, 2022
4. Medicare.gov, "Are prescription drugs covered in Medicare Advantage plans?", Last Accessed June 5, 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 January 15, 2023
7. CMS.gov, "Medicare Part C & D Performance", Last Accessed January 15, 2023