Medicare offers prescription drug coverage to everyone with Medicare. Even if you don’t take a lot of prescriptions now, it’s very important for you to consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you will likely pay a late enrollment penalty. To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and specific drugs covered.
There are two ways to get Medicare prescription drug coverage:
- Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
In either case, you must live in the service area of the Medicare drug plan you want to join.
Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium may include an amount for prescription drug coverage.
Note: Contact your drug plan (not Social Security) if you want your premium deducted from your monthly Social Security payment. If you want to stop premium deductions and get billed directly, contact your drug plan.
What you pay for Part D coverage could be higher based on your income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, a Medicare Advantage Plan, a Medicare Cost Plan, or employer group Medicare Advantage Plan that includes Medicare prescription drug coverage. If your income is above a certain limit, you will pay an extra amount in addition to your plan premium. Usually, the extra amount will be deducted from your Social Security check. For more information, visit www.socialsecurity.gov.
Other factors that influence what you’ll pay for Part D coverage:
- Yearly Deductible. The amount you must pay before your drug plan begins to pay its share of your covered drugs. Some drug plans don’t have a deductible.
- Copayments or Coinsurance. Amounts you pay for your covered prescriptions after the deductible (if the plan has one). You pay your share and your drug plan pays its share for covered drugs.
- Coverage Gap. Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there is a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you enter the coverage gap, you get a 50 percent discount on covered brand name drugs and pay 86 percent of the plan’s cost for covered generic drugs until you reach the end of the coverage gap. Not everyone will enter the coverage gap. The following items all count toward you getting out of the coverage gap:
- Your yearly deductible, coinsurance, and copayments
- The discount you get on brand-name drugs in the coverage gap
- What you pay in the coverage gap
- The drug plan premium and what you pay for drugs that aren’t covered don’t count toward getting you out of the coverage gap.
- Some plans offer additional coverage during the gap, like for generic drugs, but they may charge a higher monthly premium. Check with the plan first to see if your drugs would be covered during the gap.
- In addition to the 50 percent discount on covered brand-name prescription drugs, there will be increasing savings for you in the coverage gap each year until the gap closes in 2020.
- Catastrophic Coverage. Once you get out of the coverage gap, you automatically get “catastrophic coverage.” Catastrophic coverage assures that you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Alabama. It is for informational purposes only and some listings may be inaccurate or missing. The list was provided by the Centers for Medicare and Medicaid Services (CMS), but due to the variance in plans based on county, city, and region, some options may not be available in your location.