{"id":4986,"date":"2024-11-02T13:23:51","date_gmt":"2024-11-02T13:23:51","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/?p=4986"},"modified":"2024-11-02T13:23:51","modified_gmt":"2024-11-02T13:23:51","slug":"hmn-what-are-the-two-types-of-medicare-drug-plans-in-2024","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-what-are-the-two-types-of-medicare-drug-plans-in-2024\/","title":{"rendered":"HMN: What are the two types of Medicare drug plans in 2025?"},"content":{"rendered":"<p>\n<br \/>Do you know:  What are the two types of Medicare drug plans? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p>Medicare prescription drug plans, not included in Part A or B, are available through Part C (Medicare Advantage) or as standalone Part D plans, administered by private insurance companies.<\/p>\n<\/li>\n<li>\n<p>Eligibility for Medicare prescription drug plans requires being 65 or older, collecting Social Security Disability Insurance for at least 24 months, or having a diagnosis of End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).<\/p>\n<\/li>\n<li>\n<p>Enrollment in Medicare prescription drug plans is time-sensitive, with specific periods for initial enrollment, annual enrollment, and special enrollment based on life events or changes in eligibility.<\/p>\n<\/li>\n<li>\n<p>Costs associated with Medicare prescription drug plans vary, including premiums and deductibles, but there are ways to save on prescription drugs, such as the low-income subsidy or Extra Help program.<\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p>About 66% of adults in the United States take prescription drugs. The affordability of these medications is a common concern, as the average American spends more than <a href=\"https:\/\/data.oecd.org\/healthres\/pharmaceutical-spending.htm\" target=\"_blank\" rel=\"noopener\">$1,400 per year<\/a> on medications. Fortunately, people in this age group are eligible for Medicare coverage of prescription drugs. According to a Medicare survey by , 28% of respondents did not know that Medicare offers prescription drug coverage. Learn how to join the <a href=\"https:\/\/www.kff.org\/medicare\/issue-brief\/key-facts-about-medicare-part-d-enrollment-and-costs-in-2023\/\" target=\"_blank\" rel=\"noopener\">50.5 million people<\/a> receiving Medicare prescription drug plans (PDPs).\n<\/p>\n<h2 id=\"what-are-my-options-for-medicare-prescription-drug-coverage\"><span style=\"font-weight: 400;\">What are my options for Medicare prescription drug coverage?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">When enrolling in Medicare, many beneficiaries don\u2019t realize prescription drugs aren\u2019t included in Medicare Part A or Medicare Part B. To receive coverage for prescription medications, you must choose between a Part C Medicare Advantage plan that includes a prescription drug benefit or a stand-alone prescription drug plan under Medicare Part D.<\/span><\/p>\n<p><b> <\/b><b>Medicare Part D vs. Medicare Advantage<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Private insurance companies like Blue Cross are contracted with the Medicare program to administer Part C and Part D plans.<\/span><\/p>\n<h3 id=\"part-c\"><span style=\"font-weight: 400;\">Part C<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare Advantage plans<\/span><span style=\"font-weight: 400;\"> combine the benefits from Original Medicare Parts A and B into one privately-administered plan. Not all Medicare Advantage programs include a prescription drug benefit. However, the majority do. Eligibility for a Medicare Part C plan requires you to be enrolled in Medicare Parts A and B and live in the plan\u2019s service area.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Part C Medicare Advantage plans are most commonly offered as HMO or PPO plan options. You can expect similar prescription coverage from Medicare Advantage plans as a stand-alone Part D plan.<\/span><\/p>\n<h3 id=\"part-d\"><span style=\"font-weight: 400;\">Part D<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare Part D<\/span><span style=\"font-weight: 400;\"> is optional prescription drug coverage under Medicare. To enroll in Part D coverage, you must be eligible for Medicare Part A or enrolled in Medicare Part B.\u00a0<\/span><\/p>\n<p><b> <\/b><b>Compare Medicare Part D plans<\/b><\/p>\n<h2 id=\"what-do-medicare-drug-plans-cover\"><span style=\"font-weight: 400;\">What do Medicare drug plans cover?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Each Medicare Part D or Advantage plan has a <\/span><span style=\"font-weight: 400;\">formulary<\/span><span style=\"font-weight: 400;\">\u00a0or list of covered drugs. Part D plans aren\u2019t required to cover all prescriptions, but they must cover a certain number of drugs in each drug category. Before enrolling in a plan, review the formulary and ensure your prescriptions are covered and with as few restrictions as possible. PDP coverage breaks the prescriptions down into coverage tiers. These tiers outline the copays and costs and are broken into generic and brand-name medications.<\/span><\/p>\n<p><b>Most Medicare drug plans consist of five drug tiers:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tier 1: Preferred generics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tier 2: Non-preferred generics<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tier 3: Preferred brands<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tier 4: Non-preferred brands<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tier 5: Specialty drugs<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some plans, such as Special Needs Plans for chronic conditions, may offer an additional drug tier. Tier 6 is for prescription drugs to help with specific health issues. Each drug tier will outline the cost-sharing for prescription medications.\u00a0<\/span><\/p>\n<p><b>Medicare drug plans cover items such as:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription medications listed in the plan\u2019s formulary<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vaccines<\/span><span style=\"font-weight: 400;\"> not covered by Medicare Part B<\/span><\/li>\n<\/ul>\n<h3 id=\"whats-not-covered\"><span style=\"font-weight: 400;\">What\u2019s not covered<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare prescription drug plans only cover medications filled at retail or mail-order pharmacies. Some items aren\u2019t covered by Medicare prescription drug coverage.<\/span><\/p>\n<h2 id=\"eligibility\"><span style=\"font-weight: 400;\">Eligibility<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">To be eligible for a Medicare drug plan<\/span><span style=\"font-weight: 400;\">, you must be 65 or older, you\u2019ve collected Social Security Disability Insurance for at least 24 months, you\u2019ve been diagnosed with End-Stage Renal Disease (ESRD) and are on dialysis, or you\u2019ve been diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig\u2019s disease).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Not everyone will need to enroll in a Medicare drug plan. Some beneficiaries have current creditable drug coverage, which is a prescription drug plan that is expected to pay as much or more than the standard Medicare Part D plan, such as through a retirement health plan, Tricare, or Veterans Affairs coverage. If you don\u2019t enroll in Medicare prescription drug coverage or have creditable coverage when you\u2019re first eligible for Medicare, you may be subject to a <\/span><span style=\"font-weight: 400;\">late enrollment penalty<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The late enrollment penalty will compound monthly for each month without coverage and never goes away. The only way to remove a Part D penalty is if you qualify for state or federal assistance programs such as Extra Help, Medicare Savings Program, or <\/span><span style=\"font-weight: 400;\">Medicaid<\/span><span style=\"font-weight: 400;\">\u00a0or if you were provided incorrect information from your current drug coverage prior to enrolling in Part D. Also if your premium penalty applied to a person who is younger than 65, the penalty goes away at age 65.<\/span><\/p>\n<h2 id=\"how-much-does-a-medicare-prescription-drug-plan-cost\"><span style=\"font-weight: 400;\">How much does a Medicare prescription drug plan cost?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Regardless of whether your drug coverage is through a <\/span><span style=\"font-weight: 400;\">Medicare Advantage Plan<\/span><span style=\"font-weight: 400;\"> or a stand-alone PDP, there will be costs associated. <\/span><span style=\"font-weight: 400;\">Part D drug plans<\/span><span style=\"font-weight: 400;\"> typically have a monthly premium and\/or deductible, as do some Medicare Advantage plans.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare prescription drug plans consist of four coverage phases outlined by the Centers for Medicare &amp; Medicaid Services (CMS):<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Deductible phase: <\/b>During this phase, you\u2019ll pay a set deductible b<span style=\"font-weight: 400;\">efore your plan starts sharing the cost of medications.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Initial coverage phase:<\/b><span style=\"font-weight: 400;\"> After you meet your deductible, your plan will pay some costs of your medications, and you will pay a copay or coinsurance.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Coverage gap phase (also known as the \u201cdonut hole\u201d):<\/b><span style=\"font-weight: 400;\"> Once you and your plan have accumulated a specific amount in total drug costs, you will pay a coinsurance that\u2019s a set percentage of the cost of your medications.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Catastrophic coverage phase:<\/b><span style=\"font-weight: 400;\"> Once you have spent a certain amount of out-of-pocket costs (not including your plan premium) for covered drugs, you will have no cost-sharing for your medications.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">You can find an example of the <\/span><span style=\"font-weight: 400;\">coverage phases here<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3 id=\"other-ways-to-save-on-prescription-drugs-with-medicare\"><span style=\"font-weight: 400;\">Other ways to save on prescription drugs with Medicare<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">With the costs of prescriptions rising, everyone is looking for ways to save money on their prescription drugs. Those with a low income can apply to see if they can qualify for the low-income subsidy or <\/span><span style=\"font-weight: 400;\">Extra Help program<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If that doesn\u2019t work, check with your<\/span> <a href=\"https:\/\/www.shiphelp.org\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">SHIP<\/span><\/a><span style=\"font-weight: 400;\"> and see if there\u2019s a<\/span> <a href=\"https:\/\/www.medicare.gov\/pharmaceutical-assistance-program\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">State Pharmaceutical Assistance Program (SPAP)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another way to get financial assistance is to use <\/span><span style=\"font-weight: 400;\">\u2019s free discount prescription card<\/span><span style=\"font-weight: 400;\">. This card will give you instant savings on brand-name and generic drugs of up to 80%. Note: Using a  coupon on your prescription instead of Medicare, your out-of-pocket costs will not apply to your Medicare deductible.<\/span><\/p>\n<h2 id=\"how-to-enroll\"><span style=\"font-weight: 400;\">How to enroll<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You can call 1-800-Medicare, use your State Health Insurance Assistance Program (SHIP), or another local nonprofit to help you navigate the Part D enrollment process and ensure your medications are covered properly.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some items to consider when comparing plans are:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Is my pharmacy in the network? If so, is it preferred or standard?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are all my current prescriptions covered?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Which tiers do they fall under?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How much is the premium?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Will I reach the coverage gap phase?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What\u2019s the projected annual cost of my prescriptions and premium combined?<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The steps to enroll in Medicare prescription drug coverage include:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Decide on a Medicare Advantage plan or Part D plan. You can review the plans and enroll using Medicare.gov\u2019s<\/span> <a href=\"https:\/\/www.medicare.gov\/plan-compare\/#\/?year=2022&amp;lang=en\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">plan finder<\/span><\/a><span style=\"font-weight: 400;\"> or call 1-800-Medicare.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Check the plan\u2019s formulary<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Compare the costs associated<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Complete the enrollment form<\/span><\/li>\n<\/ol>\n<h3 id=\"when-to-enroll\"><span style=\"font-weight: 400;\">When to enroll<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Enrollment in a Medicare drug plan requires a <\/span><a href=\"https:\/\/www.medigap.com\/medicare-enrollment-periods\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">valid enrollment period<\/span><\/a><span style=\"font-weight: 400;\">. A few times annually, Medicare beneficiaries can change, drop, or add their Medicare coverage. Below, we\u2019ll describe when you can make changes.<\/span><\/p>\n<h4 id=\"initial-enrollment-period-iep\"><span style=\"font-weight: 400;\">Initial Enrollment Period (IEP)<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">Your Initial Enrollment Period occurs when you first become eligible for Medicare. For people who age into Medicare, this enrollment period allows you to start the enrollment process three months before and three months after the month in which you turn 65. Medicare beneficiaries who start Medicare before 65 will get a second IEP as they approach their 65th birthday.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When using the IEP, <\/span><span style=\"font-weight: 400;\">Medicare coverage starts<\/span><span style=\"font-weight: 400;\"> on the first of the month after the month of enrollment. Once the plan starts, it becomes locked in. Making further changes would require a new valid enrollment period.<\/span><\/p>\n<h4 id=\"annual-enrollment-period-aep\"><span style=\"font-weight: 400;\">Annual Enrollment Period (AEP)<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">The Annual Enrollment Period is the most well-known <\/span><span style=\"font-weight: 400;\">yearly enrollment window<\/span><span style=\"font-weight: 400;\">. AEP occurs from Oct. 15 to Dec. 7. During this enrollment window, you can browse coverage options and enroll or change coverage as often as you like, with the last plan you choose taking effect on Jan. 1.<\/span><\/p>\n<h4 id=\"medicare-advantage-open-enrollment-period-maoep\"><span style=\"font-weight: 400;\">Medicare Advantage Open Enrollment Period (MAOEP)<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">The Medicare Advantage Open Enrollment Period is an enrollment window for Medicare beneficiaries actively enrolled in a Medicare Advantage plan.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">During the MAOEP, beneficiaries can drop their MA plan, enroll in Original Medicare with a PDP, or change to another Medicare Advantage plan. This enrollment period begins on Jan. 1 and continues through Mar. 31.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When making a change during the MAOEP, beneficiaries can make one change. The plan change will take effect on the first day of the following month.<\/span><\/p>\n<h4 id=\"special-enrollment-period-sep\"><span style=\"font-weight: 400;\">Special Enrollment Period (SEP)<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">Outside the enrollment periods listed above, various life events can trigger a Special Enrollment Period.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some examples would be moving out of your plan\u2019s service area, receiving federal or state assistance with Medicare costs, or losing creditable coverage. Most SEPs will last for two months after the life event occurs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Many SEPs allow you to change your prescription drug coverage outside regular periods. In addition to the outlined Special Enrollment Periods, there are sometimes additional SEPs triggered by natural disasters and emergencies.<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 25.1413 9.27138 25.45 8.3206C24.6436 8.80066 23.7608 9.1389 22.84 9.3206C22.2245 8.65317 21.405 8.2089 20.5098 8.05745C19.6147 7.90601 18.6945 8.05596 17.8938 8.48379C17.093 8.91162 16.4569 9.59313 16.0852 10.4214C15.7135 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