There are several ways you may be able to fill the gaps in the Medicare drug benefit:
- There are several programs that can help people with low income pay for prescription drugs. Some of these programs coordinate with Part D.
- Keep your retiree drug coverage. Talk to your former employer to find out if your current retiree drug coverage will fill in the gaps in Medicare’s drug benefit.
- Buy an enhanced Medicare drug plan. Enhanced drug plans charge higher monthly premiums than basic plans but typically offer a wider range of benefits. These may include eliminating the deductible and/or the coverage gap and having a broader list of covered drugs (formulary). Some of these plans may also cover drugs that are excluded from Medicare drug coverage by law. Keep in mind that benefits vary by plan.
- Join a Medicare private health plan that offers the Medicare drug benefit with lower out-of-pocket costs. Medicare HMOs, PPOs and other private health plans may offer drug coverage that lowers your up-front costs (such as the deductible). However you will need to look at more than just the drug coverage. Make sure the plan covers the doctors and hospitals you prefer to use at a cost you can afford.
Keep in mind that no matter what Medicare drug plan you buy you will have to spend $5,000 out-of-pocket (just what you pay for your drugs) before your drug costs go down significantly (catastrophic coverage). (If you qualify for Extra Help catastrophic coverage works differently for you.) Once you have spent $5,000 out-of-pocket for covered drugs, you will only have to pay 5% of the cost of each covered drug, or a copay of $3.35 for generics or $8.35 for brand-name drugs, whichever is greater.
- Note: If you buy a drug that is not on your plan’s formulary or if you buy it from a pharmacy not in your plan’s network, you will generally have to pay the full cost yourself and it will not count towards your out-of-pocket maximum ($5,000 in 2018).