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How Do Prescription Drug Plans Work?

Here is important information you need to know about owning a prescription drug plan:


  • Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $545 in 2024. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.

  • Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates it's medications into tiers. Each tier has a copay amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2024, the initial coverage cap is $5030. After you and the insurance company together have paid this amount, then you enter the coverage gap.

  • The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 25% for generics. Your gap spending will continue until you have paid $8000 out of your own pocket in 2024.

  • Catastrophic Coverage – Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get "catastrophic coverage." It assures you only pay a small coinsurance percentage or copayment for covered drugs for the rest of the year.

How would I enroll?

You can learn more about how you can find the best Prescription Drug plan that has everything in place for your specific needs and budget. Schedule an appointment today and an agent will assist you:

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