2023 Medicare Part-D Plans in Pennsylvania
There are 26 Medicare Part-D Plans available in Pennsylvania from 10 different health insurance providers. You can choose from 5 prescription drug plans offering additional gap coverage. The plan with the lowest monthly premium is $5.20 and the highest monthly premium is $192.60. The highest best Part-D plan available in Pennsylvania received a 4 overall star rating from the CMS and the worst rated plan is 1.5 stars.
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Part D Changes in Pennsylvania, 2023
•26 stand-alone Medicare prescription drug plans are available in 2023. All individuals with Medicare have access to a Medicare prescription drug plan.
•100% of people with a stand-alone Medicare prescription drug plan have access to a plan with a lower premium than what they paid in 2022.
•24% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).
•$5.20 is the lowest monthly premium for a stand-alone Medicare prescription drug plan.
Cost of Pennsylvania Medicare Part D
The right plan for you depends on your budget, prescription drug costs, and what you want to pay for deductibles and premiums. The cost of Medicare Part D can include a monthly premium, co-payments and co-insurance for specific drugs, a yearly deductible, a gap in coverage called the “Donut Hole,” and catastrophic coverage once a threshold amount has been met.
- Monthly Premium
- Yearly deductible
- Coinsurance/ Copayments
- Coverage gap costs
- Late enrollment penalty
- Discounts from additional help
The actual drug coverage costs may vary based on:
- Specific prescriptions (whether prescribed drugs are listed on your plan)
- What tier your prescribed drug is on
- Phase of your drug benefit (whether you are in the catastrophic coverage phase or you have met the deductible)
- Type of pharmacy you are using (whether it is listed on the preferred pharmacy network or offers standard/preferred cost sharing)
- Generic brands are available in the market
- Price of the brand drugs change
- Newer medication becomes available
- New information about side effects or disease prevention
Things to Consider in Your Medicare Plan D
PDP embraces different drug lists formularies, tiers, pharmacy networks, and drug coverage rules that impact the drug coverages of each plan and varies by location compared to Puerto Rico. So, it is recommended to conduct a detailed review of the plan's benefits before enrolling in any drug plan. Ensure you initially check the types of drugs covered in your specific plan.
Both formularies and tiers in your PDP determine whether your prescription drugs will be covered and their out-of-pocket costs. If beneficiaries need the medication outside the drug list approved by their plan, they are likely to face higher out-of-pocket costs for those drugs. Similarly, different tiers tend to have varying costs of your prescribed drugs. If you choose the drugs listed in the lower tiers, you’ll have lower copayments compared to the drugs in the higher tiers.
How Do to Choose a Medicare Part D Plan in Pennsylvania?
There are several factors that may impact your decision to choose a prescription drug plan. Before choosing any drug plan, ask yourself the following questions:
- Specific prescriptions (whether prescribed drugs are listed on your plan)
- How many medications do I take?
- Are those medications available as generics?
- Do I have any chronic illness that needs specific medications such as nebulizers, insulin, and others?
Check the drug coverage. If you want to enroll in Medicare Advantage Plan and want your prescription drug coverage as its part, you must review the drug coverage in detail. Ensure whether it will be enough to cover the needs of your prescription drugs.
Evaluate the Cost of the Plan. Since the cost of all plans differs, it is recommended you review the drug plan options considering monthly premiums and other related costs.
Preferred Pharmacy Networks
Part D plans also have pharmacy networks that impact the cost of prescription drugs. In other words, preferred pharmacy networks serve as the tool used by the (MA-PDs) Medicare Advantage plans and prescription drug plans (PDPs) in their respective Part D plan offerings.
Under the preferred arrangements of the pharmacy network, drug plans lower the negotiated prices for Part D drugs to specific retail pharmacies. These pharmacies, in exchange, reduce the drug prices for recipients on monthly premiums, co-insurance, and co-payments. This, in turn, creates a win-win situation for both beneficiaries and the government.
Coverage Rules
Plan D has certain coverage rules that include prior authorization, quantity limits, and step therapy that limit how and when beneficiaries will receive prescription drugs. Medicare formularies have specific restrictions on some drugs, including:
- Prior Authorization. You may need to prove that you have met specific criteria to consume any drug.
- Quantity Limits. Your plan may limit the frequency and dosage amount of any prescribed drug.
- Step Therapy. Initially, you must try drugs of lower costs that have been effective for your medical condition before using the expensive form of drugs.
- Opioid Safety Limits. Plan D often does not cover opioids, and usually, doctors work with the pharmacist and patient to determine the safe dosage level for each patient.
Last updated on
Source: CMS.gov
Plans as of October 1, 2022.
For More Information on Ratings Please See the CMS Tech Notes.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.