A stand-alone prescription drug coverage plan helps cover the cost of prescription drugs. It can be an addition to an existing health plan, such as Medicare.
A stand-alone prescription drug plan helps reduce the amount people have to pay for prescription drugs. Costs of a prescription drug coverage plan may include monthly premiums, copayments, and coinsurance.
People may add a stand-alone prescription drug plan to certain Medicare plans, or they may be able to add it to another health plan if they do not have creditable drug coverage.
This article looks at what a stand-alone prescription drug coverage plan is, the potential costs involved, and how to find and enroll in a plan.
Prescription drug coverage helps cover the costs of prescription medications.
People may also call a stand-alone prescription drug coverage plan a Part D prescription drug plan. This plan provides prescription drug coverage to people with Medicare.
The drug coverage plan will contain a formulary, which lists all the drugs the plan covers and their costs.
People will pay a monthly premium for a drug coverage plan, as well as an annual deductible, copayments, and coinsurance. People with lower income or fewer resources may be eligible for extra help, which reduces the amounts people pay on a drug coverage plan.
Drug coverage plans may vary in cost and in the prescription drugs they cover. Part D plans will also usually cover vaccines, not including those that Medicare Part B covers.
People with other health plans may be eligible for stand-alone prescription drug coverage plans, but they will need to check with their health plan first to make sure they will not lose their existing coverage.
Medicare offers stand-alone prescription drug coverage in the form of a Part D drug coverage plan.
To get drug coverage with Medicare, people will need to have a health plan with Medicare or with a Medicare-approved insurance provider or private company.
People can get stand-alone prescription drug coverage with Medicare. Medicare offers drug coverage plans that people can add to certain plans, including:
- original Medicare
- Medical Saving Account plans
- certain Medicare cost plans
- certain Private Fee-for-Service plans
People will need to have Medicare Part A or Part B in order to get stand-alone prescription drug coverage.
If people have Part A and Part B, which may not offer drug coverage, they can buy the Medicare Advantage Plan (Part C), which offers drug coverage.
Costs may vary for each drug coverage plan and for the drugs the plan includes.
Part D drug coverage costs may include:
- monthly premiums
- an annual deductible
- copayments or coinsurance
- costs of a coverage gap, which may begin after people have spent a certain amount on covered drugs
- a late enrollment penalty, which people pay if they enroll outside the enrollment period
Costs of prescription drug coverage may depend on:
- whether the drugs are in a plan’s formulary, or drug list
- which tier the drugs are in, which can include both generic and brand-name drugs
- which drug benefit phase people are in, such as whether they have reached the deductible
- which pharmacy people use for their prescriptions
- whether people are eligible for extra help, which can lower costs for people with less income
Medicare offers Part D prescription drug plans for Medicare enrollees. These plans cover many prescription drugs, including those that doctors use to treat cancer and HIV.
Medicare drug plans categorize drugs into tiers depending on how much they cost. Drugs that fall into lower tiers are usually less expensive than drugs in higher tiers.
Individuals will be able to keep their current health coverage and join a separate Medicare drug plan only if they have one of the following:
- a Private Fee-for-Service plan
- a Medical Savings Account plan
- a cost plan
- certain employer-sponsored Medicare plans
If people already have creditable drug coverage, such as the Federal Employee Health Benefits Program, it may be best for them to keep their current plan. All Marketplace plans include prescription drug coverage.
All plans will contain a formulary, which is a list of drugs that the plan covers. This list will include both generic and brand-name drugs.
People may want to look through the formulary to see whether a plan covers the drugs they need and how much the drugs cost, although plans may change their formularies.
When looking for suitable drug coverage, people may also want to:
- look at coverage gap costs, which may cause them to pay higher rates for prescription drugs for a certain period of time
- consider a low deductible, if they want to balance their drug costs throughout the year
- look for drug plans with tiers that charge less for generic drugs, if they mostly use generic drugs
- consider a plan with lower monthly premiums, if they want drug coverage for peace of mind rather than to cover regular medical costs
To apply for a Medicare drug plan, people can search the Medicare Plan Finder to compare different plans.
Once people have found a plan, they can enroll for it through the Medicare website, by completing a paper form, by calling the plan, or by calling 1-800-MEDICARE.
It is important that people enroll by the correct deadline to avoid paying a late enrollment penalty.
A stand-alone prescription drug coverage plan is a Part D prescription plan, which helps cover the costs of prescription medications.
Medicare enrollees may add Part D to original Medicare.
People with other health insurance, such as employer or union coverage, may also be eligible for Part D drug coverage if they do not have creditable drug coverage.