Prescription Drug Plans (PDP)
In certain situations, especially when you are on a supplement, you need to get an individual PDP. Even if you currently are not on any medication, or on inexpensive meds, you should still get a PDP. For one thing, you will avoid a late penalty if you do not get coverage when first eligible, but you also want to have coverage should you be put on an expensive medication in the future. There are many things to consider when looking at a PDP. It is best to seek assistance. Some of the variables are.
- Should you get a plan with a deductible?
- Is a higher premium plan better overall than the lower premium?
- You must make sure your medications are on the formulary.
- If you are on expensive medications, know how coverage is going to work in the coverage gap.
- Understand the different tier levels and what your medication should cost.
A brief description of how a PDP works is:
- There are different levels of coverage, known as tiers. Generally, the higher number tier, the more the cost is to you. Tier 1 and 2 are usually generic meds, Tier 3 and 4 are preferred and then non-preferred brand-name drugs. Most items on Tier 1 and 2 can have a $0 or low copay, while the upper tiers will have higher copays or a % of the price. Tier 5 usually consists of specialty items, which are expensive.
- Once the combined amount of your cost and the insurance companies reach a certain level, you reach a coverage gap in which you would normally pay a 25% coinsurance. Tier 1 and 2 items may be covered the same in the gap.
- If you should then reach the next level in combined cost, you would be in the catastrophic coverage phase. In this phase, you pay a 5% coinsurance or a reduced copay whatever is more. This level helps protect you from excessive drug cost.
- Most plans have a deductible. You would pay this amount before coverage would begin. The deductible usually does not apply to Tier 1 drugs and sometimes Tier 2 also.
- Beginning in 2023, The Shingles and TDap Vaccines are covered at a 0 copay. (Flu, Pneumonia and Covid vaccines are covered on Part B or Medicaid)
As you can see, drug coverage can be quite complex. It is highly recommended that you have someone who will help you, and clearly explain how this all works. There is a program called Extra Help, which can assist with your drug cost. For more information refer to the financial assistance section of this website.
My Clients Needs Come First!
"Steve has been very instrumental in helping me navigate the available Medicare options. So, I was able to choose the Medicare Advantage Plan that was best for me. He has always maintained a professional demeanor. He is very pleasant and personable to interact with. He has taken an interest in me as a person, and is always available to answer any questions I may have. I look forward to many years of having Steve be my Medicare Health Insurance representative."
Teresa S.
"I found Steve through a friend for help with my Medicare plan enrollment. He was very knowledgeable and professional in getting me enrolled in the correct Medicare plan. I would highly recommend him to anyone."
Jerry C.
"I am happy with Steve’s complete communication and understanding of each and everything that I needed in reference to my Medicare health insurance. Thank you very much. I am happy in my retirement."
Timothy S.
“Steve gave me personal attention and guidance to help me get started with Medicare. He explained my options clearly, and patiently answered all of my questions. I would highly recommend working with Steve.”
John A.
"Steve was awesome in helping me find some great options for accepted Medicare insurance providers in this area as my previous provider was limiting my doctors greatly. He is great about keeping me up to date on changes as they occur. His knowledge is vast!"
Diana A.
"Steve has been very helpful in guiding us through the Medicare journey. After moving to Tennessee my wife and I had some uncertainties about changing Medicare from one state to another. Steve was very confident and reassured us in making this transition."
Doug S.
"Steve has been a Godsend for us, making our transition to Medicare as smooth as glass. He's always helpful in filling out forms, who to call, and what to do next. Patient, calm, kind and Very knowledgeable...a true gentleman. Thank you for all of your help, Steve."
Sandy A.
"Steve was awesome! He came to our home and sat with my husband and I and gave us a full rundown on our options. We were able to choose a plan that worked for us. Steve is very knowledgeable and was patient with all our questions. Not to mention keeping us informed and handling anything we needed to have done afterwards. I highly recommend Steve for your Medicare needs. He knows what he’s doing!"
Patty A.
"I thought I had the gold standard for health insurance until I met Steve who explained options, helped me decide and saved me close to $1,000. Subsequent to signing up with Steve he's been very responsive to questions as I learned about my new insurance plan. His no pressure approach was also very much appreciated. I have recommended Steve to others and will continue to do so."
Mike D.
The cure for Medicare confusion
**This is a personal website of Steve Walter and is not associated with or endorsed by any government agency. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 56 products in your area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program to get information on all of your options.