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.
You can enroll in—or change—a Part D plan:
- When you’re first eligible for Medicare, you can join during the 7‑month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
- If you get Medicare due to a disability, you can join during the 7‑month period that begins 3 months before your 25th month of disability and ends 3 months after your 25th month of disability. You will have another chance to join during the 7‑month period that begins 3 months before the month you turn 65 and ends 3 months after the month you turn 65.
- Between October 15–December 7, anyone can join, switch, or drop a Medicare drug plan. The change will take effect on January 1 as long as the plan gets your request by December 7 of the previous year.
You generally must stay enrolled for the calendar year. However, in certain situations like the following, you may be able to join, switch, or drop Medicare drug plans at other times:
- If you move out of your plan’s service area
- If you lose other creditable prescription drug coverage
- If you live in an institution (like a nursing home)
Your actual drug plan costs will vary depending on the following:
- Your prescriptions and whether they are on your plan’s formulary (drug list)
- The plan you choose
- Whether you go to a pharmacy in your plan’s network
Other important Part D-related terms you should understand:
- Premium. 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. 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.
- 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.
- 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% discount on covered brand name drugs and pay 86% 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
- Join a Medicare drug plan when you’re first eligible. You won’t have to pay a penalty, even if you’ve never had prescription drug coverage before.
- Don’t go 63 days or more in a row without a Medicare drug plan or other creditable coverage. Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or health insurance coverage. Your plan must tell you each year if your drug coverage is creditable coverage. This information may be sent to you in a letter or included in a newsletter from the plan. Keep this information, because you may need it if you join a Medicare drug plan later.
- Tell your plan about any drug coverage you had if they ask about it. When you join a Medicare drug plan, and the plan believes you went at least 63 days in a row without other creditable prescription drug coverage, the plan will send you a letter. The letter will include a form asking about any drug coverage you had. Complete the form and return it to your drug plan. If you don’t tell the plan about your creditable prescription drug coverage, you may have to pay a penalty.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Hawaii. 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.