Part D Prescription Drug Coverage
Drug Coverage Is Included With Most Peoples Health Plans
Most Peoples Health plans include Medicare Part D prescription drug coverage.
Original Medicare does not include Part D prescription drug coverage. To get it, you need to enroll in a prescription drug plan. If you don’t get drug coverage when you are first eligible, you may face a penalty if you want to sign up for it later.
One option for getting Part D coverage is a “stand-alone” prescription drug plan. This type of plan only covers prescription drugs – it does not cover any medical care. Since Part D was introduced in 2006, the average stand-alone prescription drug plan premium has increased — from about $26 per month to an estimated $41 per month for 2021.*
Another option is to choose a Medicare Advantage plan that includes prescription drug coverage. With most Peoples Health plans, you don’t have to pay for a separate prescription plan because Part D drug coverage is included.
A word of warning: If you are in a Medicare Advantage plan with prescription drug coverage and you sign up for a separate Part D plan, you will be disenrolled from your Medicare Advantage plan.
You cannot be enrolled in two plans at once that both offer Part D prescription drug coverage.
The Part D Coverage Gap – Or “Donut Hole”
The “doughnut hole” is another name for the Part D coverage gap. It’s a period where you’re responsible for a larger percentage of the cost of your drugs. The amounts may change from year to year.
In the 2021 plan year, the gap starts after you and your plan have spent $4,130 and lasts until your out-of-pocket costs reach $6,550.
In the 2022 plan year, the gap starts after you and your plan have spent $4,430 and lasts until your out-of-pocket costs reach $7,050.
Peoples Health covers all generic drugs that are on tier 1 and tier 2 of our drug list through the coverage gap.
This means your out-of-pocket costs for tier 1 and 2 generic drugs will not increase when you are in the gap. Members of Peoples Health special needs plans and members of Peoples Health Group Medicare plans are covered for all drugs during the gap.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you are eligible, you can contact the agencies below.
TTY users should call 1-877-486-2048
Social Security Administration
TTY users should call 1-800-325-0778
TTY users should call 1-800-220-5404
Or call Peoples Health, and we will help you find out if you qualify for extra help.
*Henry J. Kaiser Foundation: “Medicare Part D: A First Look at Prescription Drug Plans in 2021,” October 29, 2020.