Medicare Part D Plans in Pennsylvania

We found 25 Medicare Part D Plans in Pennsylvania.

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 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. work. So, let's start with the four cost-sharing phases.

The Deductible Phase

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.

Phase 2 is the Initial Coverage Limit

For 2022, the Part D Initial Coverage Limit (ICL) is $4.430. Your Part D plan will pay the bulk of your prescription cost during the ICL phase. If your costs exceed $4,430, then you will be in the coverage gap phase (aka "doughnut hole")

The Third Phase is a Coverage Gap

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 costs 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 2022 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 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.. 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 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... 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 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 Pennsylvania include Part D as an additional benefit.

Medicare Part D and Supplements Work Together

Medicare does not pay for all of your hospitalization and medical bills. In fact, 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. only covers about 80 percent of your major medical costs. We keep an up-to-date directory of Pennsylvania Medigap Plans, also called 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., 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 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, "How to get prescription drug coverage", Last Accessed April 28, 2022
2. Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed May 1, 2022
3. Medicare.gov, "Medicare costs at a glance", Last Accessed June 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 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 July 2, 2022.