Costs for Medicare Part D Prescription Drug Coverage

Frequently Asked Questions

You pay a monthly premium to your plan. You also pay part of your pharmacy drug costs (copays and coinsurance) and Medicare (through your plan) pays part of your pharmacy drug costs.

Your costs will vary depending on which plan you choose. However, at a minimum your plan must provide a standard level of Medicare prescription drug coverage that is set by the Centers for Medicare and Medicaid Services (CMS). For Cigna-HealthSpring Rx (PDP) plans, the Secure Plan offers the standard level of coverage.

The typical Medicare Part D Prescription Drug Plan works like this:

The typical plan has 3 phases:

Deductible and Initial Coverage – The “typical” plan has a deductible for the year. After you have paid costs equal to the deductible amount, then you have Initial Coverage. In this phase and will only pay a copay or coinsurance until you reach the Initial Coverage Limit which starts the Coverage Gap.

Coverage Gap – This is sometimes referred to as the “donut hole”. Here you pay a discounted amount for brand and generic drugs. Once your combined drug costs reach the upper level of the Coverage Gap you move to Catastrophic Coverage.

Catastrophic Coverage – You will pay a small amount for medications, typically not more than 5% of the cost. The plan pays most of the cost.

No. Medicare requires each spouse to pay separate premiums, deductibles, copays and coinsurance for prescription drug coverage. Each spouse will reach each level of coverage according to his or her own drug costs over each calendar year.

Most people will pay the standard monthly Medicare Prescription Drug (Part D) premium. However, you may have to pay an extra amount because of your annual income. For 2019, single or married individuals filing separately whose income is $85,000 or above, and couples with an income of $170,000 will pay the extra amount.

If you are impacted, the Social Security Administration (not your Medicare Part D plan) will send you a letter telling you what the amount will be and how to pay it. This extra amount must be paid separately and cannot be paid with your monthly Part D premium.

Medicare provides assistance, known as Extra Help, in paying for prescription drug costs for those with limited income and resources.

If you qualify, you will receive help paying for any Medicare drug plan's monthly premium, annual deductible (if applicable) and prescription copays or coinsurance. This Extra Help will count towards your out-of-pocket expenses.

People who receive full Medicaid benefits are automatically eligible for Extra Help with their drug costs and do not need to apply separately for the Extra Help. Medicare will mail a letter to people who automatically qualify for this assistance.

People who receive any help from Medicaid paying their Medicare premiums or receive Supplemental Security Income automatically receive Extra Help and do not need to apply separately. However, these individuals will need to enroll in a Medicare prescription drug plan.

Those who do not receive assistance from Medicaid but have limited income and resources are encouraged to apply for Extra Help and enroll in a Medicare drug plan. To receive assistance with the Medicare drug benefit, the following steps must be completed:

  • Apply for Extra Help based on your income and resources; and
  • Sign up for a prescription drug plan to begin using the benefit.