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Arizona Medicare Part D Plans

Medicare offers prescription drug coverage to everyone with Medicare. Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan.

There are 2 ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans.

These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A or Part B to join a Medicare Prescription Drug Plan.

2. Medicare Advantage Plans (like HMOs or PPOs) or other Medicare health plans that offer Medicare prescription drug coverage.

You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

In either case, you must live in the service area of the Medicare drug plan you want to join.

Which drugs are covered?

Information about a plan’s list of covered drugs (called a “formulary”) isn’t included here because each plan has its own formulary. Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is in a higher tier and your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment for the drug in the higher tier.

Monthly premium

Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium may include an amount for prescription drug coverage.

Yearly deductible

This is the amount you must pay before your drug plan begins to pay its share of your covered drugs. Some drug plans don’t have a deductible.

Copayments or coinsurance

These are the amounts you pay for your covered prescriptions after the deductible (if the plan has one). You pay your share and your drug plan pays its share for covered drugs. These amounts may vary.

Coverage gap

Most Medicare drug plans have a coverage gap (also called the “donut hole”). The coverage gap begins after you and your drug plan together have spent a certain amount for covered drugs ($3,310 for 2016). In 2016, once you enter the coverage gap, you pay 45% of the plan’s cost for covered brand-name drugs and 58% of the plan’s cost for covered generic drugs until you reach the end of the coverage gap. Not everyone will enter the coverage gap because their drug costs won’t be high enough.

These items all count toward you getting out of the coverage gap:

 ■ Your yearly deductible, coinsurance, and copayments
 ■ The discount you get on covered brand-name drugs in the coverage gap
 ■ What you pay in the coverage gap

The drug plan premium and what you pay for drugs that aren’t covered don’t count toward getting you out of the coverage gap. Some plans offer additional cost sharing reductions in the gap beyond the standard benefits and discounts on brand-name and generic drugs, but they may charge a higher monthly premium. Check with the plan first to see if your drugs would have additional cost sharing reductions during the gap. In addition to the discount on covered brand-name prescription drugs, there will be increasing coverage for brand-name and generic drugs in the coverage gap each year until the gap closes in 2020.

Catastrophic coverage

Once you have spent $4,850 out-of-pocket for the year (2016), the coverage gap ends. Once you get out of the coverage gap, you automatically get “catastrophic coverage.” With catastrophic coverage, you only pay a coinsurance amount or copayment for covered drugs for the rest of the year.


Arizona Part D Plans

When it comes to choosing Arizona Medicare Part D coverage, you have a lot of options.

Fortunately, as experts in the Arizona marketplace for Medicare Part D coverage, we can guide you to the best carriers and options that are right for you.


If you are turning 65, or if you have moved to a different county or state -- you have a special election period that allows you to enroll.

Otherwise, if you would like to join, switch or drop a Medicare drug plan -- you must generally do this during Medicare Open Enrollment Period, which occurs from October 15th to Deceber 7th each year.


Optimum Benefits Inc., Gilbert, Arizona   480-274-9264