Medicare

Understanding Medicare Part D

How much will my prescription drugs cost with Medicare?

What medications are covered?

Can I go to any pharmacy?

These are some of the most common questions people have when signing up for a Medicare plan. With the rising costs of prescription drugs, it’s important to have a good understanding of how your medications are covered. Here are answers to some of the most common questions about Medicare Part D – otherwise known as prescription drug coverage:

How does Part D fit into Medicare?

Medicare is health insurance that is available for people ages 65 and older as well as those with disabilities. There are four parts – A, B, C and D. Parts A and B make up Original Medicare, Part C is Medicare Advantage and Part D is prescription drug coverage. Most Medicare Advantage plans include prescription drug coverage.

What does Medicare Part D cover?

Medicare Part D covers self-administered prescription medications. Both brand-name and generic drugs are included.

What isn’t covered under Medicare Part D?

Most vaccines – like those for the flu and pneumonia – are covered under Medicare Part B. One exception is the shingles vaccine, which is covered under Medicare Part D. In addition, vitamins, supplements and over-the-counter medications are not covered.

Are prescription drugs free with Medicare?

One of the most common misconceptions is that prescription drugs are free with Medicare Part D. Plans have different tiers that determine how much you’ll need to pay for your medications.

What factors should I consider when selecting prescription drug coverage?

Here are five factors you should consider when looking at plans:

  • What medications do you take? Check out www.gov – the government’s Medicare website. You can type in your medications and compare how they are covered under different plans.
  • What tier are your medications on? Medicare plans have different drug tiers, each with a different copayment or coinsurance. The tier you select will help determine how much you’ll need to pay for your medications.
  • Are there are any restrictions? Some plans have restrictions on certain medications or require authorizations before prescriptions can be filled.
  • How much will you need to pay out-of-pocket before reaching the deductible? Plans differ on copayment and deductible amounts.
  • What pharmacies are part of the plan’s preferred value network? – If you have a preferred pharmacy, you’ll want to make sure it’s part of the plan’s preferred value network. Sticking within this network may end up saving you money on your prescriptions.

What is the Star rating of a drug plan? The Centers for Medicare and Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare patients’ experiences with their health plans and the health care system. This rating system applies to Medicare Advantage plans. For 2021, Network Health is the only Medicare Part D plan in Wisconsin to achieve a 5 Star rating from CMS. Overall Network Health received a 4.5 out of 5 Star rating for our PPO plans.*

What if I need help picking a Medicare plan?

If you need help picking a plan, reach out to a Network Health sales advisor or your local agent. Both are great options for learning more about what options are available and how the different plans compare with each other. Network Health also offers in-person meetings and Zoom webinars for people to learn more about their Medicare options. Learn more about these meetings by visiting networkhealth.com.

*Every year, Medicare evaluates plans based on a 5-star rating system.

Network Health Medicare Advantage Plans include MSA, HMO and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal.

Y0108_3167-01-1020_M Accepted 11032020