Medicare Part D Coverage Examples
If you don’t know someone who has Medicare Part D coverage, or you’re having a hard time picturing how
your own coverage would work, it may be helpful to read a few examples. How exactly do certain financial
or health needs align with different Medicare prescription drug plans’ coverage and benefits? You can
find out here.
The below scenarios involve fictional characters and situations that represent how
prescription drug coverage could work. It’s important to know that any costs provided are examples,
and prescription drug plan costs vary depending on the coverage provider and plan you choose.
Nancy is 65 and has recently enrolled in Medicare. She is a retired human resources manager and
lives with her husband of 40 years, William. Nancy enjoys spending time with her children and
grandchildren, boating on the nearby lake, cooking, and playing the piano.
Nancy was diagnosed with Type 2 diabetes at the age of 57 and, since then, has taken a daily diabetes drug. Combined with a healthier diet and increased physical activity, Nancy’s drug lays the foundation for managing her diabetes. After turning 65, Nancy enrolled in a prescription drug plan because she knew she would continue to need prescription diabetes drugs.
Nancy’s PDP Plan Features
- Discounted price on the diabetes drug Nancy takes
- An affordable monthly premium
- A $0 deductible so the plan begins sharing the cost immediately
- A pharmacy network that includes Nancy’s favorite pharmacy
Nancy’s Monthly PDP Plan Costs
- $29 monthly premium
- $20 copay for the Tier 2 prescription drug she takes
Robert is 66 years old and has been on Medicare for one year. Robert is a retired engineer who
is recently divorced. His son, a personal trainer, has gotten Robert interested in outdoor
activities like biking, swimming, and hiking. Robert also enjoys watching sports and traveling.
Robert hasn’t always been as healthy as he is now. Since his son got him involved in outdoor physical
activities, Robert has lost weight and feels great. He’s even beginning to pay more attention to his
diet by avoiding greasy, high-calorie foods. Robert has needed prescription drugs periodically, but
not on a regular basis.
Robert’s PDP Plan Features
- Discounted price on prescription drugs
- $415 deductible
- A low monthly premium
- A higher deductible
- A pharmacy network that includes Robert’s pharmacy
Robert’s Monthly PDP Plan Costs
- $30 monthly premium
- 45% coinsurance payment for his Tier 4 drugs