Comparing Medicare Part D Plans

Are Medicare Part D Plans All The Same? 

While prescription drug plans provide at least the standard level of coverage as it is defined by Medicare, they have the option to offer different combinations of coverage and cost sharing. 

Because Medicare Part D comes from private insurers like Anthem, you have the flexibility to compare plans and select one that fits you. Compare Medicare Part D plans by just asking a few questions when you shop for insurance. 

What Prescription Medications Are Covered? 

Every Medicare Part D plan covers different types of medications. If you use prescription drugs to manage a health condition like high blood pressure or diabetes, make sure your plan covers the medications you need most.

Medicare Part D insurers have drug lists of medicines they cover. If a plan does not cover your medicine, see if it covers a different drug that also works for you. Your doctor may know of a substitute or generic option to your medication.

What Medications Are Not Covered By Medicare Part D? 

Under most circumstances, Medicare does not allow Part D insurers to cover certain types of drugs. These include: 

Does A Medicare Part D Plan Have Any Restrictions On Coverage? 

Check to see if a plan has certain restrictions on the medicines you need, such as prior authorization and step therapy. Prior authorization requires your doctor to get permission from the insurer to prescribe certain medications. Then, the drug will be covered if your insurer pre-approves the medicine. Step therapy means you try less expensive medications to treat a condition first before trying more costly medications.

What Other Medicare Part D Costs Should You Know About? 

Look at the copays, coinsurance, monthly premiums, and deductibles across different plans, in addition to ensuring your medications are covered. Once you've found plans that cover the medications you use, compare the costs of those medicines. The price of prescription drugs often varies from plan to plan. You may want the lowest annual cost not only for premiums, but also for your estimated annual out-of-pocket costs.

Is the Medicare donut hole going away?

Yes. In previous years, you faced a coverage gap when you and your health plan spent a certain amount on your medications ($5,030 in 2024). After that you were required to pay 25% of your prescription drug costs until you reached an $8,000 annual out-of-pocket limit. Starting January 1, 2025, you will not pay anything for covered medications after you reach a $2,000 annual out-of-pocket limit.

Plus, the new rules make it easier to manage your out-of-pocket prescription drug costs. You can enroll in the new Medicare Prescription Payment Plan designed for members with high out-of-pocket prescription drug costs. This will let you make monthly payments versus paying the entire amount upfront. Participation in this program is completely optional. You will receive enrollment instructions from your health plan or give us a call if you have questions.

Are You Eligible For Extra Help For Medicare Part D? 

See if you qualify for federal assistance to pay for Medicare Part D costs. Depending on your income,  Extra Help is a federal program that can pay for some or all of your prescription drug costs.

Can You Get Generic Medications? 

Using generic instead of brand name drugs will help you save money. Make sure the prescription medications you use are available in generic form. 

Does The Medicare Part D Plan Have A Pharmacy Network? 

Check to see what pharmacies are included in a plan to fill your prescriptions and if it's convenient for where you live. There could be preferred cost-sharing pharmacies near you that may offer lower copays. Consult our online pharmacy directory at Anthem.com/find-care to learn more.

Compare Medicare Part D With Medicare Advantage 

Medicare Part D is not your only option. You could sign up for a Medicare Advantage Plan, also known as Part C, instead. Many Medicare Advantage plans include prescription drug coverage through a combined Part C and Part D plan, plus a lot more. Just like Medicare Part D plans, you can get Part C plans from private insurers like Anthem.

Medicare Advantage plans also offer the same coverage as Medicare Part A and Part B, plus vision, dental and hearing care, wellness programs, and additional benefits.