Prescription Drug Plans for Medicare
Medicare beneficiaries can choose from dozens of Part D standalone drug plans, and Medicare Advantage plans that offer prescription drug coverage. This article will cover what you need to know about Prescription Drug Plans (Medicare Part D).
Contents
Medicare’s Part D prescription drug coverage is offered through standalone Part D plans (Prescription Drug Plans, PDPs for short) and Medicare Advantage plans that offer both Part A and Part B, including Part D. About 50 million people enrolled in Medicare have Part D, either through standalone PDPs or as a component of their Medicare Advantage plan. This year, Medicare beneficiaries have dozens of Medicare Part D standalone drug plan options to choose from, and fewer choices among Medicare Advantage plans with Part D. During this year’s open enrollment period, from October 15 to December 7
What is a Prescription Drug Plan?
A prescription drug plan (Medicare Part D) covers the cost of medication you take to treat a health condition. Each plan has a list of drugs it will cover, called a drug formulary. Each medication’s price varies based on the drug’s category or tier. Typically, drugs in the lowest tier cost the least. Drugs in the highest tier cost the most. Many plans also have a deductible to pay before the plan starts covering your medications.
There are two ways to get Medicare Part D coverage: a standalone prescription drug plan or a Medicare Advantage Plan that includes prescription drug coverage. You can enroll in either of these plans during an open enrollment period or after you become eligible for Medicare, but you must choose a plan carefully. Each plan has a different monthly premium and covers drugs differently. A good place to start is by comparing the plan’s formulary, which is a list of medications covered by the plan. The plan’s deductible and copayments also vary from one to another.
Most Medicare Part D plans offer a preferred drug list that identifies lower-cost generic and brand-name medications. Most plans charge a higher cost-sharing for non-preferred drugs and for some over-the-counter medicines, such as cough syrup or antacids. Some plans do not cover certain types of medicines, including drugs used to help grow hair or lose weight and those for treating sexually transmitted diseases. In addition, Part D beneficiaries must pay for the first $250 of their drugs each year. The rest of their costs are covered by a yearly limit (the coverage gap, also known as the “donut hole“) and then by an out-of-pocket maximum each year.
The Inflation Reduction Act of 2024 will close the coverage gap and reduce out-of-pocket drug costs for all Medicare Part D enrollees in the future. However, in the meantime, you should assess your Medicare Part D plans and prescription needs on an annual basis. You can do this by reassessing your current prescription needs during the annual open enrollment period and by looking at new options.
The Most Common Prescription Drug Plans
It’s important to note that the specific prescription drug plans offered by these companies may vary by location and plan type. It’s advisable to explore the details of each company’s offerings, including formularies, preferred pharmacies, copayments, and coverage specifics, to determine the most suitable prescription drug plan for your needs. Here are the most common prescription drug plans offered by the most prestigious health insurance service providers in the U.S.:
CVS Health
CVS Health is a prominent healthcare company based in the United States. It operates through various divisions, including CVS Pharmacy, CVS Caremark, CVS MinuteClinic, and CVS Specialty. CVS Health offers a wide range of healthcare services and products to individuals, employers, healthcare providers, and government entities.
CVS Health offers prescription drug plans through its subsidiary, CVS Caremark. They provide comprehensive pharmacy benefit management services, including prescription drug coverage for individuals and employer-sponsored health plans. Their prescription drug plans aim to improve medication adherence, provide cost-effective options, and offer convenient access to medications through CVS Pharmacy locations and mail-order services.
Centene
Centene Corporation is a healthcare company based in the United States that specializes in providing managed healthcare services. It is also one of the largest managed care organizations in the country. Centene focuses on serving individuals and families who are eligible for government-sponsored healthcare programs, such as Medicaid, Medicare, and the Health Insurance Marketplace.
Centene Corporation offers prescription drug plans as part of its health insurance offerings. Through its subsidiaries, such as WellCare and Envolve Pharmacy Solutions, Centene provides prescription drug coverage to individuals and families enrolled in their Medicaid, Medicare Advantage, and Health Insurance Marketplace plans. Their prescription drug plans strive to ensure access to affordable medications and offer a wide network of participating pharmacies.
UnitedHealth
UnitedHealth Group is a diversified healthcare company based in the United States. It is one of the largest healthcare organizations globally, providing a wide range of healthcare products and services. UnitedHealth Group operates through two main businesses: UnitedHealthcare, its health insurance division, and Optum, its health services division.
UnitedHealth Group offers prescription drug plans through its subsidiary, UnitedHealthcare. Their prescription drug plans are available as standalone Medicare Part D plans or as part of Medicare Advantage plans. UnitedHealthcare focuses on providing a broad range of medications and cost-saving opportunities through their preferred pharmacy network, mail-order services, and digital tools to help members manage their prescriptions effectively.
Humana
Humana is a healthcare insurance company based in the United States. It is one of the largest providers of health insurance and related services in the country. Humana offers a wide range of health insurance plans and manages care services for individuals, families, employers, and government entities.
Humana offers prescription drug plans through its pharmacy benefit manager, Humana Pharmacy Solutions. Their prescription drug plans are available as standalone Medicare Part D plans or as part of Medicare Advantage plans. Humana emphasizes affordability and convenience, offering cost-saving options such as preferred pharmacy networks, mail-order services, and a comprehensive formulary with a wide range of covered medications.
Aetna
Aetna is a healthcare insurance company based in the United States. It provides a range of health insurance plans and related services to individuals, employers, and government entities. Aetna is one of the largest health insurance companies in the country.
Aetna, now a part of CVS Health, provides prescription drug plans through its subsidiary, Aetna Medicare. Aetna offers prescription drug coverage as standalone Medicare Part D plans or as part of Medicare Advantage plans. They strive to ensure access to a broad selection of medications at competitive prices, with a focus on cost management and member support through their network of participating pharmacies and mail-order services.
Cigna
Cigna Corporation is a global health services organization based in the United States. It provides a wide range of healthcare services, including health insurance, pharmacy benefits, behavioral health services, dental care, and more. Cigna operates in multiple countries and serves individuals, employers, and government entities.
Cigna offers prescription drug plans through its subsidiary, Express Scripts. They provide prescription drug coverage for individuals, employer-sponsored plans, and Medicare beneficiaries. Cigna’s prescription drug plans emphasize cost-effective medication options, personalized member support, and access to a large network of participating pharmacies, including mail-order services for convenient medication delivery.
HealthSprings
As part of Cigna Corporation, HealthSprings benefits from the global expertise and resources of the parent company. Cigna is a leading global health services organization, operating in multiple countries and serving millions of customers worldwide. This affiliation allows HealthSprings to tap into Cigna’s network and leverage its knowledge and experience in healthcare management
HealthSprings, specializes in Medicare Advantage plans, including those with prescription drug coverage. They offer comprehensive prescription drug plans as part of their Medicare Advantage offerings, aiming to provide affordable access to a wide range of medications through their network of participating pharmacies.
Blue Cross Blue Shield
Blue Cross Blue Shield (BCBS) is a federation of independent health insurance companies that provide coverage to millions of individuals and organizations in the United States. It is one of the largest and most recognizable healthcare insurance brands in the country. The BCBS Association is comprised of 36 separate health insurance organizations, operating in different states and regions across the United States.
Blue Cross Blue Shield (BCBS) companies operate independently in different regions of the United States, offering a variety of health insurance plans, including prescription drug coverage. BCBS prescription drug plans are available for individuals, families, and employer-sponsored health plans. They strive to provide comprehensive coverage for prescription medications and often collaborate with pharmacy benefit managers to ensure affordability and convenient access to medications.
Molina
Molina Healthcare, Inc., commonly known as Molina, is a managed healthcare company based in the United States. It specializes in providing health insurance plans and managed care services to individuals and families who qualify for government-sponsored healthcare programs, such as Medicaid and Medicare.
Molina Healthcare offers prescription drug coverage through its health plans, including those for Medicaid, Medicare, and Marketplace enrollees. Their prescription drug plans focus on affordability and accessibility, with a comprehensive formulary and preferred pharmacy networks. Molina aims to provide cost-effective options and medication management tools to help members optimize their healthcare outcomes.
