KBenefits Insurance Services
Medicare Part D

Medicare Part D Prescription

Part D Prescription Plans  - (4 stages)

Stage 1:  Rx Deductible:
The amount you must pay for health care or prescriptions, before Original Medicare, your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay.  For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Stage 2:  Initial Rx Coverage Level:
Once you have met your yearly deductible, and until you reach the plan's out-of-pocket maximum, you pay a copayment (a set amount you pay) or coinsurance (a percentage of the total cost) for each covered drug.

Stage 3:  Rx Coverage Gap:
Starting January 1, 2011, if you reach the coverage gap (also called the "donut hole") in your Medicare prescription drug coverage, you will get approximately a 50% discount on covered brand drugs. Medicare has also increased its coverage of generic drugs for beneficiaries in the coverage gap so that beginning in 2011 you will pay less for generic drugs as well. The drugs eligible for the brand discount or the additional generic savings may change based on the information we have available.


Stage 4:  Catastrophic Rx Coverage:

Once you reach your plan's out-of-pocket limit during the coverage gap, you automatically get "catastrophic coverage."  Catastrophic coverage assures that once you have spent up to your plan's out-of-pocket limit for covered drugs, you only pay a small coinsurance amount or a copayment for the rest of the year.


Prior Authorization (PA):
Prior authorization means that you will need prior approval from an insurance plan before you fill your prescription.  Call your plan or visit their Web site to learn more about specific prior authorization requirements.  Knowing what the prior authorizations are before going to your doctor's office may save you time at the pharmacy counter.


Quantity Limit (QL):
For safety and cost reasons, plans may limit the quantity of drugs that they cover over a certain period of time. If the drug has a quantity limit restriction, you should contact the plan for more details.


Step Therapy (ST):
In some cases, plans require you to first try one drug to treat your medical condition before they will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, a plan may require your doctor to prescribe Drug A first.  If Drug A doesn't work for you, then the plan will cover Drug B.


Shopping Medicare Part D:
1)  Log onto Medicare.gov.

Click:  "Find Plans"
Click:  "Continue without logging in"

Select:  "Drug Plan (part D)"
Enter:   "Zip Code"


Select  "I don't get help from any of these programs"

Select  "Yes"

Select  "both"

2)  ENTER Rx:



View Part D Carrier Plan options.
Make sure you search the plan options by "premium + out of pocket expenses".
  You can print/save the report for your records.


2021  Part D Prescriptions
ranked by monthly premium


SilverScript SmartRx (PDP)
$7.30    $445.00 deductible


Wellcare Wellness Rx (PDP)
$14.80   $445 deductible


Wellcare Value Rx (PDP)

$16.30   $445 deductible


Horizon BCBS Blue Saver (PDP)
$23.50   $150 deductible

Humana Walmart Value Rx (PDP)
$17.02   $445 deductible

MOO Premier (PDP)
$26.00  $445 deductible

Wellcare Medicae Rx Select (PDP)
$28.50   $345 deductible

SilverScripts Choice (PDP)
$33.60  $300 deductible

Star Ratings 2021
Part D Prescription Drug Carriers:

AARP Medicare Rx Preferred:          3.5 out of 5
AARP Medicare Rx  Saver Plus:       3.5 out of 5
AARP Medicare Rx  Walgreens:      3.5 out of 5


Horizon Blue Rx saver          3 out of 5
Horizon Blue Rx standard    3 out of 5
Horizon Blue Rx enhanced  3 out of 5

Humana Walmart Value:  3 out of 5
Humana Preferred Rx:      3 out of 5
Humana Basic Rx:             3 out of 5

Mutual of Omaha Value:   (too new for rating)
Mutual of Omaha Plus:      (too new for rating)

SilverScripts Choice:     4 out of 5
SilverScripts Plus:          4 out of 5
SilverScripts SmartRx:   4 out of 5

Wellcare Wellness:    3.5 out of 5
Wellcare Value:          3.5 out of 5
Wellcare Classic:        3.5 out of 5



Reference: www.state.nj.us/humanservices/doas/documents/SHIP_PartD_Stand_Alone2020.pdf

Star Rating System explained. 
Medicare's Star Rating System measures the performance of Medicare Advantage and Part D plans.  The Rating System scores how well plans perform in several categories:  quality of care and customer service.  Ratings range from 1.0 to 5.0 stars, with five being the highest and one being the lowest.  You can use the overall star rating to compare performance among several different plans but it's most important to make sure the plan you choose has your prescriptions covered their their formulary list.   Medicare reviews plan performance yearly and releases new star ratings each fall.

Part D plans (PDP) are rated on how well they perform in four different categories:
   *  Drug plan customer service
   *  Member complaints
  *   Problems getting services
  *   Choosing to leave the plan
   *  Member experience with the drug plan
   *  Drug pricing and patient safety

Medicare Advantage plans (MAPD) (Part C) are rated on how well they perform in five different categories:
    *  Staying healthy: screenings, tests, and vaccines
    *  Managing chronic (long-term) conditions
    *  Plan responsiveness and care
    *  Member complaints

    *  Problems getting services
    *  Choosing to leave the plan
    *  Health plan customer service

Christopher S. Kudryk
Insurance Specialist

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