2023 Medicare Part D Drug Coverage

If you need Medicare Part D prescription drug coverage, we can help. We are an independent insurance agency specializing in senior health plans. We represent all prescription drug carriers direct to our clients.

Navigating Medicare drug plans can be difficult. If you make a mistake, you can face monetary penalties and enrollment delays. We will help you shop for and enroll in the Part D coverage that best fits your needs.

It is important to know that Part D Rx plans complement – and are in addition to – government-run Medicare Parts A and B. These are drug plans offered by private insurance companies like Aetna, Anthem Blue Cross & Blue Shield, Cigna, Humana, Mutual of Omaha, SilverScript, United Healthcare (AARP), Wellcare, and others.

In order to enroll in a Part D plan, you must also be enrolled in Medicare Part A and/or Medicare Part B. Typically, drug coverage is purchased during open enrollment at age 65 or when your Medicare Part B becomes first active. You must also know that the supplemental coverage you choose affects your Medicare Part D enrollment options.

Many Medicare Advantage plans already include Part D drug coverage. There are no Medicare supplement policies sold today (by rule) that include RX coverage, however. Enrolling in one plan can void the other. For instance, if you enroll in a Part D drug plan, then also enroll in most Advantage plans, your Part D coverage will be canceled by Medicare. It’s important to know how one affects the other.

Stand-alone Medicare Part D plans can be changed every year during the Annual Election Period (AEP). This window begins on October 15th and ends on December 7th each year. Beginning October 1st, you can review plans for the following year. Enrollment in a new Rx plan is guaranteed so long as you are Medicare-eligible.

There are no medical underwriting requirements for drug plans. You cannot be turned down due to poor health or utilization. Plans purchased during Open Enrollment will be effective January 1st of the following year.

Watch Our Video: See How To Shop & Compare Part D Plans

There are four stages to most Part D plans: The Deductible Phase, Initial Coverage Phase, Coverage Gap (aka Donut Hole), and finally the Catastrophic Phase. Not all plans have a Deductible, but those that do, don’t always apply it to all prescription tiers. In many cases, Tier I and II generic drugs are covered without the insured needing to meet the deductible.

In 2023, the maximum deductible for any plan is $505 ($25 more than in 2022). Some charge less, however. In fact, a few plans have a $0 deductible, but those poicies typically have higher monthly premiums.

After the deductible is the Initial Coverage Phase. During this window, the insurance company pays more and you pay less for your prescriptions. It’s not uncommon for the insurance company to pay 75% of the cost in the Initial Coverage Phase. This phase does not occur until both you can your plan have spent $4,660 combined on covered drugs.

Next comes the Coverage Gap – more commonly referred to as the Donut Hole. Most people don’t reach it, but if you do, you pay a larger share of your prescription amounts. This window begins at $4,660 and ends once both you and your Part D plan have reached total costs of $7,400 in covered prescriptions.

Some insurance companies cover generics at a lower percentage in the Coverage Gap/Donut Hole. For 2023, there is a discount in the Donut Hole of 75% for drugs on your formulary. Nevertheless, you can expect to pay about the same as 2022 amounts on covered prescriptions in this phase.

The final stage is the Catastrophic Coverage Phase. It begins once you and your selected Part D drug plan have paid $7,400 combined on covered prescriptions. In the Catastrophic Phase, you pay a small copay (or coinsurance amount) should you reach it. Most copays are under $10 in this stage.

The reduction/elimination of the Medicare Part D Donut Hole in 2020 applies in 2023. However, it’s important to note that consumers (and Part D providers) will need to spend more before they reach the catastrophic phase. The hope is that the Donut Hole Discount will help to alleviate some financial burdens.

By rule, all Medicare supplement coverages sold today do not include prescription drug coverage of any kind. This means if you purchase a traditional Medicare supplement (like Plan A, C, D, F, G, N, etc.) and you also want a Part D plan, then you must purchase the two separately. They can be offered from the same company, but they are always going to be separate policies.

If you choose not to enroll in a traditional supplement and remain only on Medicare Parts A and B, then you can always purchase a stand-alone prescription drug plan (PDP) from the carrier that best suits your needs. There are no requirements to purchase a Medicare supplement in order to enroll in a Part D plan.

If you purchase an Advantage plan that includes credible drug coverage, then you do not need to (nor should you) purchase a stand-alone Part D plan. Some Advantage plans (like Private Fee for Service, Medicare Cost, and Medical Savings Accounts) do not include drug coverage and allow for the purchase of stand-alone drug coverage.

It is important to note that there are some Medicare Advantage plans (HMO and PPO plans for instance) that do not include credible drug coverage. And these plans do not allow you to purchase a stand-alone drug plan based on the HMO or PPO plan design.

If you try to enroll in a stand-alone PDP plan and your Advantage plan already offers coverage (or does not allow for it) you can be automatically disenrolled from your existing Advantage plan as this overlap will be found in the Medicare (CMS) system.

When considering a Medicare Advantage plan, it’s important to understand if it includes credible drug coverage, allows for the purchase of a stand-alone PDP plan, or neither.  It can be wise to work with a knowledgeable agent to make sure you know what your Advantage plan allows for.

Most PDP carriers offer two or three drug plans to choose from.

It’s important to base your decision on a few factors. This includes plan premiums, your Rx’s, preferred pharmacies, deductibles, copays, and plan ratings.

In most states, there are several low-cost Part D Drug plans for 2023. Aetna SilverScript, WellCare, Humana, and a few others will have plans under $20 a month. The very lowest priced plan will be the SilverScript SmartRx PDP. It’s under $10 a month! This plan works well for those on few or no prescriptions.

Many Part D insurance policies will have up to a $505 one-time deductible in 2023. It’s important to note that most lower cost generic prescriptions (usually Tier I & Tier II) are not subject to this deductible.

If you would rather have a plan without a deductible, then SilverScript Plus is an option. Some Rx costs might be higher, so it’s important to factor in your copay amounts before enrolling. It’s the overall picture – not just your monthly premiums – to consider. You also want to consider your preferred pharmacy and mail order options.

At no extra cost, we offer a comparison and enrollment tool. Click on the green link in the box on the right to compare, shop and enroll on your own. This works much like the Medicare Plan Finder tool, but you don’t need to create an account. You can also save your progress anonymously to be used each year.

It is smart to shop your Part D Drug plan yearly during the AEP Medicare Open Enrollment window. It runs from Oct. 15th through Dec. 7th. Plan premiums, deductibles, copays, and drug tiers can and usually change year over year. Pricing your drugs during the AEP window helps to avoid unpleasant surprises on renewal.

Like all things insurance related, there can be penalties (both in terms of time and money) for non-compliance. The Medicare Part D program was designed to encourage enrollment and participation. If you do not enroll when you are supposed to, Medicare will enforce a premium penalty when you do.

The penalty is equal to 1% of the base plan premium for each month of non-compliance. If you enroll 12 months late, then your premiums will be 12% higher from the established base premium by Medicare – not the plan you choose. The Medicare Part D base premium cost for 2023 is estimated to be $31.50. It was 2022 is $33.37, $33.06 in 2021, and $32.74 in 2020. Once assessed, the late enrollment penalty is for life. It does not go away.

And if you are enrolling late, then you can only enroll during AEP each year. This time period runs from October 15th through December 7th – with the coverage taking effect the first day of January the next year. Unless you have a Special Election Period, you will have to wait until AEP to enroll. This delay will also increase the penalty.

Special Election Periods are for those who are on Medicaid and other government assistance as well as those who might be moving in or out of a nursing home or plan service area. Otherwise, they are not offered for many other reasons.

It is important to note that some seniors already have creditable drug coverage and do not have to purchase a Part D plan in order to avoid penalties. Most military veterans have access to creditable coverage through the VA, certain union plans will offer creditable coverage, and those who are still working and covered under their large group employer plan usually have creditable prescription plans.

If you are not sure about when or if you need to enroll then talk with an agent, your HR director and/or a Medicare agent to make sure that you are following the guidelines that apply to you individually.

If enrollment issues, penalties and plan selection weren’t enough to worry about, high income earners must also be aware of IRMAA. This acronym stands for Income Related Medicare Adjustment Amount. It’s a fancy way of saying that Part D premiums are means adjusted.

To see where you and/or your spouse may fall, please see the chart below:

2023 Part D Income Related Medicare Adjustment Table

Simply stated, individuals with adjusted gross income (from 2 years ago) exceeding $97,000 and joint filers exceeding $194,000 will pay more for their Part D plans. This premium increase affects all plans. It includes stand-alone coverage and Part D which is part of a Medicare Advantage policy. (IRMAA fees apply to Medicare Part B premiums as well.)

In some cases, you can protest your IRMAA costs if your employment income has changed due to retirement. It’s advisable to contact Medicare directly to discuss the process.

We are an independent insurance agency representing all of our many carriers direct to consumers. We specialize in Supplements, Advantage Plans, and Part D coverage.

We are a one-stop shop for your Medicare insurance needs in 2023 and beyond. Contact us today to discuss your options.