San Diego Medicare Prescription Drug Plans

When you sign up for Medicare you have the opportunity to cover your prescription drugs. Yes, your prescription drugs are going to be covered by Medicare but it is not as simple as signing up for Original Medicare and then attempting to pick up your prescriptions. In fact the Medicare program has multiple ways that you can get your prescription drugs covered.

Part D prescription drug plans are standalone drug plans that allow you to select a plan that covers your prescription drugs at a cost that you want. These standalone plans are awesome because our team is able to evaluate which Part D Drug plan is best for you by calculating the costs of each drug you take. We can then predict how much you will spend each year. Supplement plans do not cover prescription drugs so you'll want to pair your Supplement plan with one of these Part D prescription drug plans to complete your Medicare coverage. Instead of a Part D Drug plan paired with a Supplement plan, others decide to enroll in an advantage plan. These Advantage plans include prescription drug coverage and bundle all of the services are bundled into a single Medicare Plan.

​Our team at HealthyMarks is more than happy to help you identify which prescription drug strategy is best for you here in San Diego County. In San Diego we have access to multiple prescription drug plans through UnitedHealthcare, Blue Shield and other carriers and is important to make sure that you have a professional who can help you understand these plans and make the best decision for you.

How to Evaluate and enroll in a prescription drug plan

To be eligible for a Medicare prescription drug plan you must first be enrolled in Medicare is part A & B. Without joining original Medicare you cannot join a Medicare prescription drug plan. You are eligible to enroll in your Original Medicare during the initial enrollment period three months before and three months after your 65th birthday. This initial enrollment period is the same for your prescription drug plans. It is best to make your entire Medicare decision together as a whole because all of these pieces pair together really well. Our HealthyMarks team would love to help you evaluate your medical and prescription drug needs to make the best decision about your Medicare.

To evaluate which plan is best for you, our team calculates the costs for your prescriptions depending on each plan available to you. Our team has developed an amazing calculator that measures the costs for all San Diego medicare plans you are eligible for and identifies which will be the most cost efficient. Access to a local pharmacy of your choosing is also a factor when deciding which plan is best. 

Don't make these Medicare enrollment decisions alone! Our HealthyMarks team is here to help.

Standalone Part D Prescription Drug Plans in San Diego

Part D prescription drug plans are some of the most common ways to cover your prescription drugs here in San Diego. Because so many choose to select a Supplement Plan like Plan F or Plan G, pairing a standalone Part D prescription drug plan is extremely common. These standalone plans offer nationwide access to pharmacies so you can be confident you'll be able to pick up your prescription drugs wherever you may be in the United States.

 

HealthyMarks is here to help you understand which plan is the best bang for your buck.

Premiums for Part D Prescription Drug plans in San Diego

UnitedHealthcare offers the most robust selection of Part D plans here in San Diego. These plans range from just under $30 a month all the way into the $100 - $200 range. The discrepancy is due to how the drugs are covered. The less expensive plans may require you to pay a deductible before your plan kicks in. The less expensive plans also charge the insured more for each prescription they take. Blue Shield offers 2 great Part D standalone prescription drug plans as well. The less expensive plan costs just $42 a month while the more expensive plan add on costs $120 a month. These plans are more streamlined than the UnitedHealthcare offerings because there are only two options.

Prescription drug plans that you purchase standalone will have their own premium each month. This means you will pay for Original Medicare, pay for your Supplement Insurance plan, and then pay for your premium for your prescription drug plan. While Original Medicare Costs $144.60 and the best San Diego Supplement Plan G costs $153.12 per month, your prescription drug plan should only cost roughly $30 - $120 depending on how much you wish to spend. 

 

If you spend more each month on your plan, you will likely pay less for each drug you need. However, let us take guessing out of the equation. Our Medicare experts are awesome at gathering information about which drugs you take, at what quantities, and which pharmacy you would like to pick up your drugs. With this information we are able to calculate exactly which plan is going to be most cost-efficient for you.

San Diego Advantage Plans with Drug Coverage

While many choose the Supplement Plan paired with a standalone Part D prescription drug plan, the other option is to get all your services including medical coverage, dental and vision, and your prescription drugs covered by an Advantage Plan. These Advantage plans in San Diego are designed to streamline your care in a way that is simple and cost-efficient for both you and the insurance provider. Because of this, many of these plans are extremely inexpensive for you the medicare enrolled. You'll spend less each month on an Advantage plan compared to a Supplement plan.

The major downside to a Advantage plan is that you are restricted by which doctors and facilities you can see. With a Supplement Plan you can see any doctor throughout the United States. However Medicare Advantage plans here in San Diego create a network that you must stay within. You will also need to visit specific pharmacies that are paired with your Advantage plan.

 

If you are interested in bundling all of your services including dental, vision, and prescription drug coverage into a single Medicare Advantage plan our HealthyMarks team here in San Diego North County is able to come and visit with you and share with you exactly which plan and which strategy is best for you and your drug coverage.

Premiums for Advantage Plans with Drug Coverage in San Diego

Premiums are generally very inexpensive for a strong Advantage plan here in San Diego County. This one premium will cover the cost for your medical coverage, cover the cost for your deductible on the medical side, as well as provide prescription drug coverage. Premiums for Advantage Plans range from only a few dollars a month all the way to a hundred dollars or more each month. UnitedHealthcare, Anthem Blue Cross, and Blue Shield all offer the most interesting Advantage plans.

How do Drug Costs work for Medicare Plans?

The first piece of the cost is your monthly premium. You have to pay a certain amount of money each month to join these plans. After paying your monthly premium, you may have a drug deductible. This means you pay for your own drugs until your costs reach the deductible. For example, if you have a drug deductible of $500, you are responsible for the first $500 of your drug costs.

 

Many drug plans do not have a deductible! This is a huge relief meaning your drug coverage will kick in immediately when you purchase your first prescriptions. 

 

Furthermore, many generic drugs are considered "deductible waived" within your plan. This means you do not have to pay for your own generic drugs when you are still paying towards your deductible. Instead, you will simply pay a small co-pay for these drugs. In this scenario, the drug deductible only applies to the Preferred Brand Drugs. 

 

Here is an example of how drug coverage works using a UnitedHealthcare Advantage plan here in San Diego:

Annual Deductible: $500

Tier 1: Preferred Generic Drugs - $0 copay (Deductible Waived)

Tier 2: Generic Drugs - $10 copay (Deductible Waived)

Tier 3: Preferred Brand Drugs - $131 copay

All prescription drugs are not created equal. Some drugs are more expensive to manufacture, some drugs have expensive patents, and some drugs are easier to prescribe at a less expensive cost to both the insurance carrier and the insured. Insurance carriers have created what's called a "Drug Formulary" outlining every drug and which tier it is. Obviously, the insurance carrier would like you to take generic drugs to save us all on costs. Still, sometimes these rare drugs are medically necessary. These drugs are labeled as tier 3 or "preferred brand drugs". These drugs will cost much more than a generic drug.

Working with the team at HealthyMarks gives you an advantage regarding prescription drugs because our team is excellent at getting drugs approved for our clients at less expensive costs than you would be able to on your own.

If you are ready to hear from a Medicare professional about how they can help you save money on your prescitpions, give us a call!

Deductibles Co-pays and the Donut Hole for Medicare Prescription Drug Plans

Here are the 4 common elements of a medicare drug plan. First, you may have a Deductible. You’ll be responsible for the costs of your drugs up until you reach your deductible. Many drug plans do not have a deductible so you skip to the 2nd stage of your coverage: The Initial Coverage Period.


During this Initial Coverage Period, you’ll pay a co-pay or a co-insurance and the plan pays the rest. For example, these are the costs a patient would pay on the UnitedHealthcare plan listed above:

Tier 1: Preferred Generic Drugs - $0 copay (Deductible Waived)

Tier 2: Generic Drugs - $10 copay (Deductible Waived)

Tier 3: Preferred Brand Drugs - $131 copay

You stay in the Initial Coverage Period stage until your total drug costs have reached $4,020 in 2020. This number changes each year and will be more in 2021. After you complete the Initial Coverage Period, you enter the Coverage Gap also called the “Donut Hole”.


When you’re in the Coverage Gap, you’ll pay up to 25% of the costs of brand-name prescription drugs and up to 25% of the price of generic drugs. If your out-of-pocket costs reach the limit for Catastrophic Coverage ($6,350 in 2020), you have reached your final plan stage: Catastrophic Coverage. With Catastrophic Coverage, you pay just a small co-pay or coinsurance amount for all your covered prescriptions for the rest of the year.


What is most important to remember is that your prescription drugs will cost different amounts throughout the year. Being in the Donut Hole and paying extra for your prescriptions can be frustrating. The federal government is gradually shrinking the coverage gap for Medicare Part D Plans.

Will my unique drug needs be covered when I switch to medicare?

It is often a scary feeling when you sign up for a new prescription drug plan because insurance carriers do not all allow the same drugs to be taken. It is fairly common that an insurance carrier will reject a request for a certain drug because there is a less expensive generic drug capable of the same thing. This is something to be aware of but not to be feared. Insurance carriers are encouraged to find ways to save money when they cover you as a Medicare patient. One of those ways is to encourage you to select generic drugs.


However if your doctor decides that a generic drug is not the best drug for you, your medicare provider will allow you to take the more expensive and unique preferred drug.

there is something called the appeals process which will allow you to confirm with your doctor that you need this drug and then ask your Medicare provider to cover that drugged at a cost that makes sense to everyone.

How do I appeal for a drug to be covered when my medicare provider says it wont be covered?

The appeals process ensures you are able to get the drugs you require. First, you will want to confirm with your doctor that you need this drug because they are vital to the appeals process. You will then ask your Medicare provider to cover that drug at a reasonable cost that makes sense to all parties. At that point your medicare provider will reach out to your doctor to confirm you are in need of this unique drug.

Our Medicare professional team is great at navigating the appeals process and we would love to help you understand how to make sure that the drugs you need are covered at a reasonable cost. Because drugs can be expensive, sometimes it is beneficial to pay more each month in your monthly premium so that your drugs can be covered at a less expensive cost each month. It is our job as are Medicare professionals to identify the best plans for you and calculate how much money you will be sending each month and year on your prescription drugs.

Should I ask HealthyMarks for help when I select my Medicare Prescription drug plan here in San Diego?

YES! We are here to help! Our services are free to you and we do not want you to make this decision on your own because you do not need to do this on your own.  Our team is contracted with the San Diego insurance carriers so our services are free to you!  Allow us to help you navigate the difficulty of selecting a prescription drug plan.

To learn more, please visit our home page at HealthyMarks.com

© 2020 by HealthyMarks Insurance Services

Keaton Marks License #0L47187

760-484-0979    -    San Diego

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