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.

Meet Nancy

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’s Health

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 on Tier 1 and 2 drugs
  • A pharmacy network that includes Nancy’s favorite pharmacy

Nancy’s Monthly PDP Plan Costs

  • $29.30 monthly premium
  • $1 copay for the Tier 2 prescription drug she takes

Meet Robert

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’s Health

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
  • $0 deductible on all tiers so the plan begins sharing the cost immediately
  • A pharmacy network that includes Robert’s pharmacy

Robert’s Monthly PDP Plan Costs

  • $66.20 monthly premium
  • 50% coinsurance payment for his Tier 4 drugs