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Medicare Part D

Medicare Part D (Prescription Drug Coverage) is the part of the Medicare program designed to help subsidize the amount members pay for their prescription drugs.

Medicare Part D

Medicare Part D (Prescription Drug Coverage) is the part of the Medicare program designed to help subsidize the amount members pay for their prescription drugs.

Unlike Original Medicare (Medicare Parts A and B), Medicare Part D prescription drug coverage is administered by private companies. You have to sign up for coverage with a Medicare-approved Part D plan in order to receive benefits.

Why Choose Part D Coverage?

Paying for prescription drugs out-of-pocket is a fast way to rack up medical-related debt. Without coverage, many people may not be able to afford the monthly bill for their needed drugs. And without coverage, there is no limit to the amount you may pay in a year for prescriptions.

How to Get Medicare Part D Coverage

There are two ways you can get Medicare Part D coverage:

The first is to sign up for a stand-alone Part D plan. This means that you will pay a monthly premium to a Part D plan in addition to any premiums you pay for your medical coverage and your Part B premium each month. Many people who have Original Medicare, a Medicare Supplement, or a Medicare Advantage plan that does not include Part D coverage choose this option.

The second way is to enroll in a Medicare Advantage plan that includes Part D coverage. Memorial Hermann Advantage plans are Medicare Advantage plans that include prescription drug coverage. You get all of your Part A, Part B and Part D prescription coverage with just one identification card. Find out how much you may be able to save on prescription drugs you take with a Memorial Hermann Advantage plan. Speak with a representative today at (866) 350-2715 (TTY 711).

Coverage Limits — the Part D “Donut Hole”

Most Part D plans have a temporary limit on what the plan will cover, also called the coverage gap or “donut hole.”

The donut hole begins after you have met your plan deductible and have spent a certain amount for covered drugs. This amount is $4,020 in 2020. After you and your plan have reached this limit, you pay 25% of the plan’s cost for covered brand-name prescription drugs and 25% of the price for generic drugs. Not everyone will enter the coverage gap.

Once you have spent $6,350 in out-of-pocket costs on prescription drugs in 2020, you’re out of the coverage gap and have reached “catastrophic coverage.” At this point, you will only pay a small coinsurance amount or copay for covered drugs for the rest of the year. See your Summary of Benefits for more details:

Summary of Benefits

Formularies and Networks — Part D Coverage

With most Medicare Part D prescription drug plans and Medicare Advantage plans that include Part D coverage, pharmacy networks are involved. If you have an HMO plan, this means that you may be required to go to a network pharmacy. You may also have access to a mail order pharmacy, which may discount your prescription costs if you order several months at a time.

The Memorial Hermann Advantage HMO plan is designed to be easy to use where you live or work, so there are convenient pharmacy locations throughout the Greater Houston Area. Find a network pharmacy near you.

Most plans also use a formulary or drug list. This lists all of the prescription drugs covered by the plan. Within the formulary, some drugs may cost more depending on if they are brand name or if the drug company charges more for that specific drug. Drugs are categorized within the formulary by how much they cost. This is called a tier system. The easiest way to find out how much you would pay for the prescriptions you use as a Memorial Hermann Advantage plan member is to call our Customer Service team today at (855) 645-8448 (TTY 711) 8 a.m. to 8 p.m. CST, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CST, Monday - Friday from April 1 – Sept. 30.

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