Understand Your Medicare Drug Coverage Costs | Anthem.com Skip To Main Content
Health Insurance Basics

Understand Your Medicare Drug Coverage Costs

September 05, 2017

Are you thinking of getting  Medicare Part D prescription drug coverage? Because it’s not included in Original Medicare, you may be wondering how to get it — and what it might cost.

What Costs to Expect With Medicare Prescription Drug Coverage

There are two main ways to enhance your health benefits with a Medicare prescription drug plan, which are available from private insurance companies:

  1. Sign up for Original Medicare (Parts A and B) and add a prescription drug plan (PDP), known as   Medicare Part D
  2. Get your Medicare benefits through a Medicare Advantage plan (Part C) that includes Medicare Part D prescription drug benefits, known as an MA-PD

In either case, your Medicare drug costs can include monthly payments, deductibles, and copayments or coinsurance for each prescription. Let’s look at each of these in detail.

How Much Does Medicare Cost With Drug Coverage.

You will have a Medicare premium, or monthly fee, for most Part D plans (PDPs) or Medicare Advantage plans that include prescription drug benefits. The amount is set by the company that provides your plan, so be sure you find out what the monthly payment they charge is before you sign up.

Typically, you’ll receive a bill directly from the private company. Or you can contact them and arrange to have the monthly payment deducted straight from your Social Security check.

What Does Medicare Cost? Most PDPs Have Annual Deductibles.

A Medicare Part D deductible is the amount you must pay out of pocket each year before your drug plan begins to pay its share of your covered drugs. Some drug plans don’t have a deductible, which means you may find their premium is a little higher. A couple more things to note:

  • Limits apply to yearly deductibles. For 2017, the Part D deductible cannot exceed $400.
  • If you qualify for the federal Extra Help program, you may not have to pay the full deductible.
What Are Other Medicare Costs?

After the deductible, if you have one, you will need to pay a portion of the costs for your prescriptions, as either a copayment or coinsurance. A copayment is a set amount, such as $5 for any generic drug. Coinsurance is your percentage of the drug’s costs; for example, your plan might pay 90% of the cost while you pay 10%.

The specific amount you must pay per prescription varies depending upon your plan and:

  • Whether your prescriptions are on your plan’s list of covered medications (also called a formulary).
  • Which “tier” your covered drug is assigned to. Generic drugs typically costing less than brand name and specialty drugs.Enrolling in a Medicare Advantage Plan (Part C), with or without prescription drug coverage.
  • Which pharmacy you use, including whether it offers preferred or standard cost sharing, is out-of-network, or is a mail order service.
  • Whether you qualify for the Extra Help program to pay your Part D costs.
Coverage Gap Costs

Most Medicare prescription drug plans also have something called a coverage gap, which you may have heard called the “donut hole.” It’s an annual limit on benefits that kicks in after you reach a certain amount you and your plan have spent together on covered drugs. Here’s what you should know:

  • You might not enter this gap if your drug costs aren’t high enough.
  • If you do hit the limit ($3,700 in 2017), you might have to pay the whole cost of your medications for the rest of the year, usually at a discounted amount.
  • For 2017, those amounts are 40% of the plan’s cost for covered brand name drugs and 51% of the plan’s cost for covered generic drugs.
  • If your spending reaches the end of the gap ($4,950 out of pocket in 2017), you get what is called “catastrophic coverage,” which begins paying up to 95% of covered drugs again for the rest of the year.
  • Some plans provide extra coverage or cost sharing reductions when you’re in the gap, but may charge a higher premium each month.

Keep in mind, each Part D plan is different and your Medicare drug coverage may change on January 1st of each year. So you may want to compare your plan’s monthly payment, deductible, copayments or coinsurance to other plans on an annual basis.

Y0114_17_32332_I 08/14/2017
68209MUSENMUB

Anthem Blue Cross Life and Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Anthem Blue Cross Life and Health Insurance Company depends on contract renewal. Anthem Blue Cross Life and Health Insurance Company (Anthem) has contracted with the Centers for Medicare & Medicaid Services (CMS) to offer the Medicare Prescription Drug Plans (PDPs) noted above or herein. Anthem is the state-licensed, risk-bearing entity offering these plans. Anthem has retained the services of its related companies and authorized agents/brokers/producers to provide administrative services and/or to make the PDPs available in this region. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

Anthem Blue Cross is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意:如果您使用非英語的其他語言,您可以免費獲得語言援助服務。請致電聯絡客戶服務部(聽語障用戶請致電:711)。