You don’t have to spend hours going over your Medicare Part D plan options. Here, we show you how simple finding the best plan can be. 

If your Medicare Initial Enrollment Period is approaching, you have a lot to consider. There’s Medicare Part A, Part B, Part C, and Part D—which can seem like a lot to take in. Medicare Part D is a prescription drug coverage plan regulated by the Centers for Medicare & Medicaid Services

If you’re not currently taking any prescription medications, you might think that enrolling in Medicare Part D doesn’t make sense given your current situation. However, you may end up spending more money in the long run by not enrolling in prescription drug coverage from the start. Late enrollment penalty fees can quickly stack up, which is why it’s generally recommended to at least enroll in a basic Part D plan if you are enrolled in Original Medicare.

With 31 Medicare Part D plans to choose from in North Carolina, you have a variety of options and are bound to find one that fits your budget and coverage needs. In this guide, we’ll review the top-rated prescription drug plans offered in North Carolina and go over the basics you should know about Medicare Part D. Empowered with this knowledge, making a decision on your own should come easy.

Did you know the Insurify Medicare comparison tool helps you compare Part D plans confidentially? Just enter your ZIP code to uncover options in your area in less than 2 minutes!

What Are the Best Medicare Part D Plans in North Carolina?

In North Carolina, you’ll find 31 Medicare Part D plan options to choose from—all varying in cost, benefit details, service area coverage, and more. Although Medicare Part D is regulated by the Centers for Medicare & Medicaid Services (CMS), all Part D plans are offered by private insurance companies. Since each insurance company has developed its own relationships and contracts with healthcare providers, you’ll find that each insurer will offer different health plan coverage.

When it comes to finding the best Medicare Part D plan, the truth is that what works best for someone else might not work best for you. Healthcare needs are highly personal, so it’s difficult to pin down one universal “best” plan. The top eight plans based on the CMS star rating system are a good place to start, though. 

The CMS star rating system takes into consideration important factors like prescription drug costs (co-payments and coinsurance), monthly deductibles, customer service, and more.

#1 WellCare Classic S4802-081 (PDP)

    • Monthly premium: $24.90
    • Deductible: $445
    • Star rating: 4/5

With an affordable monthly premium, low deductible, and great co-pays for generic drugs, it’s no wonder this prescription drug plan received a high rating. Tier 1 generic drugs range between $0 and $6 and Tier 2 generic drugs range between $3 and $24, whether you choose to pick up your prescription at the pharmacy or receive it in the mail. Tier 3 brand-name drugs cost $30–$114, Tier 3 drugs have a 35 to 42 percent coinsurance, and Tier 5 specialty drugs have a 25 percent coinsurance

#2 WellCare Value Script S4802-143 (PDP)

    • Monthly premium: $17.20
    • Deductible: $445
    • Star rating: 4/5

Whether you choose to pick up your prescriptions at the pharmacy or sit back and receive them by mail, this plan’s formulary has the same co-payment and coinsurance costs for either method. This plan also has the second-lowest monthly premium, with affordable co-pays on generic drugs. Tier 1 generic drugs cost $0–$15, Tier 2 generic drugs cost $7–$36, and Tier 3 brand-name drugs cost $43–$141. The coinsurance for Tier 4 drugs is on the higher side, ranging from 49 to 50 percent.

#3 WellCare Wellness Rx S4802-177 (PDP)

    • Monthly premium: $15.30
    • Deductible: $445
    • Star rating: 4/5

This 4-star plan has the lowest monthly premium of the top eight plans reviewed here. Like the other plans we’ve reviewed so far, this plan’s formulary has the same co-payment and coinsurance rates for pharmacy pick-up and mail-order prescriptions. With this plan, you’ll see great savings by visiting or ordering from the insurer’s preferred pharmacies. By purchasing from a pharmacy on the plan’s preferred list, Tier 1 generic drugs are free. On the other hand, the co-pay will range between $8 and $24 at a non-preferred pharmacy. 

#4 AARP MedicareRx Preferred S5820-007 (PDP)

    • Monthly premium: $86
    • Deductible: $0
    • Star rating: 3.5/5

Although this plan has a monthly premium on the high end, it may be worth it for those who strongly prefer a zero-deductible plan. With this plan, you’ll find savings by ordering 90-day quantities of your prescription medication through the mail versus picking up at a pharmacy. Based on the plan’s formulary, a 90-day supply of Tier 1 or Tier 2 drugs is $0 through mail order. If you opt to pick up a 90-day supply at the pharmacy, that could range between $15 and $45 for Tier 1 drugs and between $30 and $60 for Tier 2 drugs.

This plan also has a unique gap coverage phase that offers a co-pay between $10 and $60 for Tier 2 generic drugs and 25 percent coinsurance for all other drugs. Most plans tend to offer a coinsurance rate for all tiers during the gap coverage phase.

#5 AARP MedicareRx Saver Plus S5921-353 (PDP)

    • Monthly premium: $26.50
    • Deductible: $445
    • Star rating: 3.5/5

With an affordable monthly premium and mail-order prescription option, this prescription drug plan is solid. Note that with mail-order prescriptions, this plan only allows you to order 90-day quantities. However, if you only need a 30-day quantity of a prescription, you still receive coverage if you choose to pick it up at a pharmacy. Tier 1 generic drugs range between $1 and $18, Tier 2 generic drugs range between $6 and $33, and Tier 3 brand-name drugs are $34–$117. The coinsurance is 40 percent for Tier 4 drugs and 25 percent for Tier 5 specialty drugs.

#6 AARP MedicareRx Walgreens S5921-390 (PDP)

    • Monthly premium: $38.60
    • Deductible: $445
    • Star rating: 3.5/5

This plan has affordable co-pays, with free 30-day and 90-day quantities of Tier 1 generic drugs when purchased at a preferred pharmacy. This plan also has a unique gap coverage phase that provides a co-pay rate for Tier 2 drugs. If you purchase from a preferred pharmacy, 30-day quantities are just $6, and 90-day quantities are $18. At a non-preferred pharmacy, 30-day quantities are $20, and 90-day quantities are $60. All other tiers have a 25 percent coinsurance during the gap coverage phase.

#7 Cigna Secure-Essential Rx S5617-287 (PDP)

    • Monthly premium: $23
    • Deductible: $445
    • Star rating: 3.5/5

With this plan, it definitely saves to purchase prescriptions from the plan’s preferred pharmacy list. For instance, Tier 1 generic drugs are just $0 when you purchase 30-day or 90-day packs at a preferred pharmacy. The co-pay jumps up to $19–$57 when purchased from a non-preferred pharmacy. With these jumps in cost, it’s a good idea to see if the pharmacies near you—that you personally prefer—are on the plan’s preferred pharmacy list.

#8 Cigna Secure-Extra Rx S5617-253 (PDP)

    • Monthly premium: $60
    • Deductible: $100
    • Star rating: 3.5/5

While this plan has a higher monthly premium, it also has a lower deductible than most other plans. Depending on your needs, the lower deductible may balance things out and make the monthly premium worth it to you. With this plan, you’ll also see some savings by ordering 90-day supplies through the mail from the plan’s preferred pharmacy list. For example, a 90-day supply of Tier 1 generic drugs by mail order would be $0, and a 90-day supply by pharmacy pick-up would be $12.

Ready to find a Medicare Part D plan that works for you? Use the Insurify Medicare comparison tool to find plans near you. Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!

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How Much Does Medicare Part D Cost in North Carolina?

In North Carolina, you won’t find any premium-free Medicare Part D plans. The lowest monthly premium you’ll find is $7.20, all the way up to $112.70. Annual deductibles will range between $0 and $445, depending on the plan you choose. 

When you budget for a Medicare Part D plan, remember to consider costs outside of the monthly premium. Think of all the out-of-pocket costs, like your deductible, co-payments, and coinsurance. If you’re currently taking several medications or take medication frequently, a plan with a slightly higher deductible but lower co-pays may be a better value than a low-premium plan that doesn’t have the greatest co-pays or coinsurance rates.

What Is Medicare Part D?

Medicare Part D is prescription drug coverage that supplements a health insurance plan that does not already offer drug coverage. For this reason, Medicare Part D plans are typically used by those enrolled in Original Medicare (a.k.a. Medicare Part A and Medicare Part B). 

If you have a Medicare Advantage plan, which typically offers drug coverage, then you wouldn’t be able (and won’t have a need) to add a Medicare Part D plan on top of that.

What Is the Medicare Part D Enrollment Process?

All birthdays are important, but your 65th birthday is one you’ll want to pay close attention to. This is because your Medicare eligibility opens up during a seven-month period that’s based on your 65th birthday. This is called your Initial Enrollment Period, which begins three months prior to your 65th birthday and ends three months after. During this period, it’s critical to enroll in Medicare benefits to avoid late enrollment fees. It’s advised to enroll in Medicare Part A, Medicare Part B, and Medicare Part D coverage

Remember, you are not locked into the plan(s) you choose during this period. If your needs change or you’ve reviewed plan options and realize another plan is a better fit, you always have the chance to change it. You can join or switch to a new prescription drug plan during the annual Open Enrollment Period, which happens October 15 to December 7.

What Coverage Phases Do North Carolina Medicare Part D Plans Include?

Medicare prescription drug plans include three phases of coverage. 

    • Initial Coverage Phase: Once you’ve met your plan’s annual deductible, you enter the initial coverage phase. This phase includes a cost-sharing formulary, which is essentially a chart of tiers that breaks down the prescription drug costs you’re responsible for. 
    • Gap Coverage Phase: Just as the name implies, this phase helps cover the gap between your initial coverage phase and the catastrophic coverage phase. Once you’ve met the plan’s annual out-of-pocket threshold of $4,131, you enter this phase. Most plans offer a 25 percent coinsurance on prescriptions during this phase, but as seen in this guide, some plans may offer co-pays for certain tiers during this phase.
    • Catastrophic Coverage Phase: Once your annual out-of-pocket costs exceed $6,550, you enter this phase of coverage. For most plans, you will pay the higher of $3.70 or 5 percent for generic drugs and $9.20 or 5 percent for brand-name drugs. 

If you have questions about how these coverage phases work, you can get in touch with your plan’s insurer. You can also reach out to the CMS at Medicare.gov or call 1 (800) MEDICARE. TTY users can call 1 (877) 486-2048.  

FAQ: North Carolina Medicare Part D

Am I eligible for a Medicare Part D plan?

If you are a Medicare beneficiary, you are eligible to enroll in a Medicare Part D plan. To be eligible for Medicare benefits, you must be a U.S. citizen or permanent resident over the age of 65. There are also special circumstances that may qualify you for Medicare coverage even if you are under 65. These include being diagnosed with end-stage renal disease (ESRD) and having received Social Security Disability Insurance for 24 consecutive months. 

Can I add a Medicare Part D plan to my Medicare Advantage plan?

If your Medicare Advantage plan offers drug coverage (and most do), then no. Medicare beneficiaries with health plans that already offer drug coverage cannot enroll in a Medicare Part D plan.

I have Medicare Supplement Insurance (Medigap). Should I enroll in a PDP plan? 

That depends. If your Medigap plan does not include drug coverage, then you can enroll in a Medicare Part D plan. However, if your Medigap plan already includes drug coverage and you definitely want a particular Part D plan, you will need to call your insurer to remove drug coverage from your Medigap plan. Keep in mind that once you remove drug coverage from your Medigap plan, you can't get it back.

What if I can't afford the cost of Medicare Part D?

The Extra Help program might be a good option for you. This is a federal financial assistance program that helps people who meet certain income requirements. If you're feeling stuck, you can also get in touch with North Carolina's Seniors' Health Insurance Information Program (SHIIP). This state program provides free and unbiased counseling on Medicare and can be very helpful if you need help or another opinion. 

Conclusion: Save Time by Comparing Plans Online

When it comes to finding the right Medicare Part D plan, you’ll save time and money by comparing plans online. Once you have a good idea of what your general needs, preferences, and budget are, searching for plans online is a breeze. 

Remember to think through things like:

    • Your monthly and annual healthcare budget
    • The number of prescriptions you’re currently taking
    • Whether you take generic, brand-name, or specialty medications
    • Which pharmacies you prefer and are most convenient for you
    • If you’d like the option of mail-order prescriptions

Once you’ve considered these factors, comparing plans online is simple. With the Insurify Medicare comparison tool, you can even customize your search by provider, premium cost, and medication.

Save money on Medicare Part D with the Insurify Medicare comparison tool. Discover plans, compare your options, and find the plan that’s right for you. Try it now!

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Updated May 7, 2021

Emily Vasquez is a content marketing writer based in Tampa, Florida. A graduate from the University of South Florida, Emily has worked as a copywriter, communications lead, and content strategist for high-growth start-ups and global brands and retailers. You can learn more at www.emvwrites.com