Whether you live in a quiet town in Upstate New York or amongst the hustle and bustle of NYC, you have many excellent healthcare options for Medicare prescription drug plans.
Most residents of New York state can enroll in Medicare health insurance at age 65. Those who meet special eligibility requirements, such as those using Medicaid services or those with end-stage renal disease, can join earlier.
Here’s a look at the four core parts of Medicare coverage:
- Medicare Part A: insurance for inpatient hospital care
- Medicare Part B: medical insurance that covers doctor visits and outpatient care
- Medicare Part C: This is Medicare Advantage. It usually includes prescription drug coverage, called MA-PD, and offers nursing home or skilled nursing facility care coverage.
- Medicare Part D: This is prescription drug coverage for Medicare beneficiaries who opt for Original Medicare.
Everyone who participates in Medicare signs up for Part A and Part B. To get prescription drug coverage, you can opt to use either Original Medicare or Medicare Advantage. For prescription drug coverage with Original Medicare, you need to add Part D. These stand-alone plans offer tiered pricing on a range of medications.
Medicare Advantage is an insurance plan (HMO, PPO, or special needs plan) that offers some extras, like wellness plans, dental coverage, and preventive care. You may pay an additional premium for this plan on top of Medicare Part B fees and any applicable fees for Part A.
What Are the Best Medicare Prescription Drug Plans in New York?
New York offers many prescription drug plans from national insurance companies. All have three- to four-star ratings, and one is premium-free.
#1: WellCare Classic S4802-077 (PDP)
- Monthly Premium: $ 34.80
- Deductible: $445
- Tier 1: $0 co-pay
- Tier 2: $4 co-pay
- Tier 3: $30 co-pay
- Tier 4: 33 percent coinsurance
- Tier 5: 25 percent coinsurance
This four-star plan is an excellent bargain for the amount you pay for prescription medications versus the monthly premium. After you reach $4,130 in drug costs, you will pay 25 percent coinsurance until your out-of-pocket costs reach $6,350. After that point, you’ll have the greater of a five percent co-pay or $3.70 for generics and $9.20 for brand-name drugs.
#2: WellCare Value Script S4802-138 (PDP)
- Monthly Premium: $17.70
- Deductible: $445
- Tier 1: $0 co-pay
- Tier 2: $6 co-pay
- Tier 3: $43 co-pay
- Tier 4: 47 percent coinsurance
- Tier 5: 25 percent coinsurance
With a relatively low monthly premium, this prescription drug plan has free Tier 1 drugs, but Tier 4 medications have a higher coinsurance than most other plans. Once you exceed your initial coverage phase, gap coverage is 25 percent coinsurance. You pay the greater of $3.70 (generic drugs) and $9.20 (brand-name drugs) or five percent in the catastrophic coverage phase.
#3: WellCare Wellness Rx S4802-172 (PDP)
- Monthly Premium: $15.60
- Deductible: $445
- Tier 1: $0
- Tier 2: $5
- Tier 3: $40
- Tier 4: 46 percent coinsurance
- Tier 5: 25 percent coinsurance
Rounding out the four-star prescription drug plans is the WellCare Wellness Rx plan. Of the plans with monthly premiums, this is the cheapest and offers similar pricing to the other two WellCare plans.
#4: AARP MedicareRx Preferred S5805-001 (PDP)
- Monthly Premium: $94.80
- Deductible: $0
- Tier 1: $5
- Tier 2: $10
- Tier 3: $45
- Tier 4: 40 percent coinsurance
- Tier 5: 33 percent coinsurance
This AARP MedicareRx Preferred plan with a three-and-a-half-star rating is from UnitedHealthcare. It has the highest monthly premiums of these eight PDP plans in New York. The upside is that there is no deductible. Pricing for Tier 3 and Tier 4 medications is comparable with the other plans. Again, the same costs apply once you exceed the gap phase. You will pay the higher amount of five percent of the price or $3.70 for generic drugs and $9.20 for brand-name drugs.
#5: AARP MedicareRx Saver Plus S5921-379 (PDP)
- Monthly Premium: $70.10
- Deductible: $445
- Tier 1: $1
- Tier 2: $8
- Tier 3: $31
- Tier 4: 40 percent coinsurance
- Tier 5: 25 percent coinsurance
Another AARP plan, this one is the second most expensive in terms of monthly premiums. One positive is that it offers lower prices than the previous AARP plan for all tiers. If you max out your initial coverage, you will pay 25 percent coinsurance until you reach the catastrophic coverage level.
#6: AARP MedicareRx Walgreens S5921-382 (PDP)
- Monthly Premium: $40.90
- Deductible: $445
- Tier 1: $0
- Tier 2: $6
- Tier 3: $40
- Tier 4: 40 percent coinsurance
- Tier 5: 25 percent coinsurance
The monthly premium for the AARP MedicareRx Walgreens plan is $40.90 per month, with a $445 deductible. Costs for prescription drugs at in-network pharmacies are similar to, and sometimes cheaper than, the higher-priced plans.
#7: Cigna Secure-Essential Rx S5617-282 (PDP)
- Monthly Premium: $24.00
- Deductible: $445
- Tier 1: $0
- Tier 2: $2
- Tier 3: 18 percent coinsurance
- Tier 4: 40 percent coinsurance
- Tier 5: 25 percent coinsurance
The Cigna Secure-Essential Rx plan has an affordable monthly premium of just $24. Its prices for Tier 1 and Tier 2 prescription drugs are very low, at $0 and $2, respectively. It is unique from the others in that you pay a percentage in coinsurance for Tier 3 medications, not a flat co-pay. The 25 percent gap coverage kicks in after exceeding your initial coverage portion of the plan.
#8: Cigna Secure-Extra Rx S5617-248 (PDP)
- Monthly Premium: $50.00
- Deductible: $100
- Tier 1: $4
- Tier 2: $10
- Tier 3: $42
- Tier 4: 50 percent coinsurance
- Tier 5: 31 percent coinsurance
This mid-priced plan has the second-lowest deductible of the plans that made the top eight list. The trade-off for the $100 deductible is slightly higher costs for most tiers. Like all the other plans, gap coverage starts when you reach $4,130 in drug costs. Gap coverage is 25 percent until you reach catastrophic coverage level ($6,350 in expenses).
How Much Do Medicare Prescription Drug Plans Cost in New York?
Medicare prescription drug plan costs vary by location, so while some people may have access to premium-free or low-cost plans, others may not. Plans tend to range from under $20 to $100 or more.
The plan’s monthly premium isn’t the only factor in the overall cost. Here are some of the other expenses that you will pay as part of your drug coverage:
- Deductible: Most, but not all, plans have a deductible to meet before a higher level of coverage kicks in. Until you meet the deductible, you pay the full price. The full price is a discounted price—not the retail price—that your insurance company has negotiated with the pharmaceutical company.
- Co-payments: Once you meet your deductible, you pay your share of the cost through a co-pay. This can range from $0 for some Tier 1 drugs to $40 or more for Tier 3 prescriptions.
- Coinsurance: This is similar to a co-pay. Coinsurance is a percentage of the full price. Again, this is the discounted price of the medication, not the retail price. Coinsurance percentages vary, but many fall between 20 and 50 percent.
You may qualify for a low-income subsidy, which would further reduce your costs. Those who are dual-eligible for Medicare and Medicaid can use Part D and Extra Help to cover prescription drug costs.
The EPIC program from the New York State Department of Health is another way to lower your prescription drug costs. The EPIC Card is available to Part D enrollees and helps cover drug costs after you meet your deductible.
What Is Medicare Prescription Drug Coverage?
In simple terms, Medicare prescription drug coverage is insurance that covers your medication costs. It works in combination with Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Medicare prescription drug coverage is available to all who enroll in Original Medicare. While it is not necessary to select a Part D plan during your Initial Enrollment Period, it’s wise to do so. Waiting to add a Part D plan until you need one may cost you significantly more.
Not all Medicare Part D plans cover every prescription drug, so it’s essential to verify that your prescriptions are on the plan’s formulary (list of medications). Be sure to compare a variety of plans because not all plans cover the same drugs. You can learn more by calling the insurance company that operates the plan.
FAQ: New York Medicare Part D
Are Medicare prescription drug plans free?
The short answer is no. While a plan may be premium-free, you still need to consider the cost of your medication. These costs include the deductible, co-pays, and coinsurance. Some plans have no deductible, so be sure to compare plans to know what costs you need to pay for your medications.
Can I add a prescription drug plan to my Medicare Advantage plan?
In most cases, no. You cannot have both a Part D prescription drug plan and a Medicare Advantage plan that already offers prescription drug coverage. Only Medicare beneficiaries with medical savings account plans and private fee-for-service plans can add Medicare Part D because those plans do not cover prescription medications.
Should I buy a prescription drug plan even if I don’t take medications?
Although it’s tempting to save money now by not purchasing a PDP, you may need one in a few years. You can join it in the future, but late enrollment will incur a penalty fee added to your monthly premiums. This isn’t a one-time fee but one that you pay every month.
You can switch plans later, during the Open Enrollment Period and possibly during a Special Enrollment Period. So, for now, it is best to choose a basic plan with no or low monthly premiums. If the time comes that you need medication long-term, you can move to a more suitable plan.
How can I sign up to receive Medicare prescription drug benefits?
You will first need to be a part of the Medicare or Medicaid programs. Enrolling in Medicare is easy. You can register at your local Social Security office, online at Medicare.gov, or over the phone by calling the Medicare offices at 1 (800) 633-4227. TTY users can contact 1 (877) 486-2048. Additionally, they can help you with signing up for the assistance program, Extra Help.
