Medicare Part D Drug Plans in Southern Utah

What is Medicare Part D?

Part D is Medicare prescription drug coverage. It is offered by private insurance companies approved by Medicare. Original Medicare (Part A and Part B) does not include most outpatient prescription drugs, so people who keep Original Medicare usually add a stand-alone Part D plan. Many Medicare Advantage plans include drug coverage in the same plan.

• Stand-alone Part D plan (PDP): used with Original Medicare, with or without a Medicare Supplement plan.
• Medicare Advantage with drug coverage (MA-PD): drug coverage is part of the Medicare Advantage plan.

How Part D plans differ

• Formulary: each plan has a list of covered drugs, and plans sort drugs into tiers that affect what you pay.
• Pharmacies: plans have pharmacy networks, and some pharmacies are preferred, meaning your cost may be lower there. Mail-order options may exist.
• Costs: premiums, deductibles, copays, and coinsurance vary by plan and by drug.
• Rules: some drugs may require prior authorization, step therapy, or quantity limits.
• Yearly out-of-pocket limit: Medicare drug plans have an annual cap on what you pay for covered drugs. The amount is set each year, so we confirm the current figure during your review.

How to compare plans

1. Make a list of your medications with dosages, and how often you take each one.
2. Check each drug against each plan formulary, including its tier and any restrictions.
3. Check your pharmacy. Is it in the network, and is it a preferred pharmacy?
4. Look at your estimated total cost for the year, not only the monthly premium.
5. Review again every year. Plans can change their drug lists, tiers, and costs from one year to the next.

Late enrollment penalty: why timing matters

If you go 63 days or more in a row without Part D or other creditable drug coverage after you first become eligible, you may owe a late enrollment penalty. The penalty is added to your Part D premium for as long as you have Part D coverage. Creditable coverage means drug coverage that is expected to pay, on average, at least as much as the standard Medicare drug plan.

That is why many people who take few medications still choose a drug plan. If you are turning 65, see our Turning 65 guide. If you have employer or retiree coverage, ask the plan whether it is creditable before you decide to drop or skip Part D.

Help paying for drug costs

If your income and savings are limited, you may qualify for Extra Help, also called the Low-Income Subsidy, which can lower premiums, deductibles, and copays for Part D. Medicare Savings Programs and Medicaid may also help in some situations. You apply through Social Security or your state, and we can point you in the right direction. Your local State Health Insurance Assistance Program (SHIP) offers free counseling as well.

Part D and Medicare Advantage

If you are in a Medicare Advantage HMO or PPO plan, joining a stand-alone Part D plan can end your Medicare Advantage enrollment and return you to Original Medicare. Check with us before you add or change a drug plan so you do not lose coverage you meant to keep.

When you can join or change a Part D plan

• Initial Enrollment Period: around your 65th birthday.
• Annual Enrollment Period: October 15 through December 7, with changes effective January 1. See our Annual Enrollment page.
• Special Enrollment Periods: certain events, such as moving or losing creditable coverage, may let you join or change plans at other times.
• Medicare Advantage Open Enrollment: January 1 through March 31 for people already in a Medicare Advantage plan.