Adding prescription drug benefits to your Medicare coverage can help you save on the costs of your prescriptions. See the top plan options in Texas, and learn how Medicare Part D drug plans work with existing Medicare coverage.
If you have Medicare, you may have all the health insurance coverage you need for regular medical and hospital care. However, if you take prescription medications or want to be prepared for suddenly needing expensive prescriptions, you might consider a Medicare Part D prescription drug plan.
Since these insurance plans are provided by private insurance companies, benefits and costs can vary from plan to plan. To pick the best option, be sure to compare plan premiums, deductibles, and covered prescriptions and their costs.
Need help comparing Medicare prescription drug plans before you talk to an insurance agent? Try the Insurify Medicare comparison tool to understand your options.
To help you compare Medicare prescription drug plans, below are the top eight plan options in Texas for 2021. These plans were ranked based on their Medicare star rating and the costs of their monthly premiums, deductibles, co-pays, and coinsurance.
In the plans below, there are five drug tiers, each with different costs. The tiers are Tier 1 for preferred generic, Tier 2 for generic, Tier 3 for preferred brand, Tier 4 for non-preferred, and Tier 5 for specialty. The costs listed below are for preferred cost-sharing 30-day drug prescriptions.
1. WellCare Classic
2. WellCare Value Script
3. WellCare Wellness Rx
4. AARP MedicareRx Preferred
5. AARP MedicareRx Saver Plus
6. AARP MedicareRx Walgreens
7. Blue Cross MedicareRx Basic
8. Blue Cross MedicareRx Plus
To check whether a medication you take is covered by a plan, you’ll need to see that specific plan’s formulary on the provider’s website. You can also learn more about protected drug classes—or drug types that plans must cover—at Medicare.gov.
Monthly Premium: $19.50
Deductible: $445
Tier 1: $0
Tier 2: $1
Tier 3: $35
Tier 4: 35 percent coinsurance
Tier 5: 25 percent coinsurance
This prescription drug plan achieved a four-star rating from Medicare. The costs above are the lowest costs for the initial coverage phase, which is after you pay the deductible but before you reach the 2021 initial coverage limit of $4,130. After you reach that limit, both generic and brand-name drugs require 25 percent coinsurance.
The highest costs you’ll pay with this plan for your medications are for standard 90-day supplies, at $3 for Tier 1, $6 for Tier 2, $126 for Tier 3, and 45 percent coinsurance for Tier 4.
Monthly Premium: $15.30
Deductible: $445
Tier 1: $0
Tier 2: $6
Tier 3: $43
Tier 4: 49 percent coinsurance
Tier 5: 25 percent coinsurance
Also a four-star plan, this WellCare drug plan is close in affordability to the first option. For the standard 90-day prescriptions, the most expensive options, you’ll pay $15 for Tier 1, $33 for Tier 2, $141 for Tier 3, and 50 percent coinsurance for Tier 4.
Monthly Premium: $17.90
Deductible: $445
Tier 1: $0
Tier 2: $4
Tier 3: $40
Tier 4: 46 percent coinsurance
Tier 5: 25 percent coinsurance
This plan is the last four-star option on the list, and its premium, deductible, and lowest costs for drugs are similar to the second WellCare plan on the list. Within the initial coverage phase, drug costs max out at $24 for Tier 1, $45 for Tier 2, $141 for Tier 3, and 50 percent coinsurance for Tier 4 for standard 90-day supplies.
Monthly Premium: $85.10
Deductible: $0
Tier 1: $5
Tier 2: $10
Tier 3: $45
Tier 4: 40 percent coinsurance
Tier 5: 33 percent coinsurance
This plan is the first option on the list with 3.5 stars. It’s also the first option with a $0 deductible, but the monthly premium is higher than the WellCare plans. The highest costs you’ll pay in the initial coverage phase for your prescriptions are for standard 90-day supplies, at $45 for Tier 1 drugs, $60 for Tier 2, $141 for Tier 3, and 45 percent coinsurance for Tier 4.
Note that for this plan, you can also expect to pay $0–$90 co-pays for some Tier 2 drugs in the gap coverage phase instead of the standard 25 percent coinsurance for generic and brand-name drugs.
Monthly Premium: $44.30
Deductible: $445
Tier 1: $1
Tier 2: $8
Tier 3: $38
Tier 4: 40 percent coinsurance
Tier 5: 25 percent coinsurance
While this 3.5-star plan does have a deductible, its drug costs and monthly premium may provide a better value for you than the first AARP plan on the list. The 90-day standard drug costs are the plan’s highest, at $18 for Tier 1, $39 for Tier 2, $129 for Tier 3, and 40 percent coinsurance for Tier 4, all lower than the previous plan’s costs.
Monthly Premium: $31.90
Deductible: $445
Tier 1: $0
Tier 2: $6
Tier 3: $40
Tier 4: 40 percent coinsurance
Tier 5: 25 percent coinsurance
Also a 3.5-star plan, this one is close in premium, deductible, and preferred 30-day drug supply costs to the previous AARP plan. However, its highest drug costs stand out a bit more, with $45 for Tier 1, $60 for Tier 2, $141 for Tier 3, and 45 percent coinsurance for Tier 4 90-day standard drug supplies.
In the gap coverage phase, you can also expect to pay $6–$60 for some Tier 2 drugs instead of the standard 25 percent coinsurance you’d usually pay for drugs in that phase.
Monthly Premium: $59.40
Deductible: $445
Tier 1: $1
Tier 2: $4
Tier 3: 13 percent coinsurance
Tier 4: 43 percent coinsurance
Tier 5: 25 percent coinsurance
This 3.5-star plan has one of the highest monthly premiums on the list. Its standard 90-day prescription costs are rather affordable, though, at $24 for Tier 1, $33 for Tier 2, 15 percent coinsurance for Tier 3, and 45 percent for Tier 4.
Monthly Premium: $154.70
Deductible: $0
Tier 1: $0
Tier 2: $2
Tier 3: $30
Tier 4: 40 percent coinsurance
Tier 5: 33 percent coinsurance
The final drug plan on the list also has a 3.5-star Medicare rating. It doesn’t require a deductible, but its high premium balances out the costs. Its top drug costs for standard 90-day supplies are $21 for Tier 1, $27 for Tier 2, $111 for Tier 3, 45 percent coinsurance for Tier 4, and 33 percent coinsurance for Tier 5.
Note that this plan also has a special $0–$21 co-pay for Tier 1 drugs in the gap coverage phase, while other covered drugs in that phase would require the standard 25 percent coinsurance.
Start comparing plan options in your service area today! Take the Insurify Medicare comparison tool for a test drive to find the best plan for you.
In 2021, the average cost of a Medicare Part D plan premium in Texas is $41.51, and the highest premium a plan can offer is $445. In addition, the initial coverage period for Part D plans ends once drug spending reaches $4,130 through a combination of beneficiary and plan payments, and the catastrophic coverage phase for Medicare beneficiaries begins at $6,550 in out-of- pocket costs.
The coverage gap between the initial coverage and catastrophic periods is known as the “donut hole.” In this period, you’ll pay a maximum of 25 percent coinsurance for drug costs. If you reach the catastrophic phase, you’ll have small coinsurance or co-payment amounts through the end of the year for covered drugs.
Medicare prescription drug plans, or Medicare Part D, provide coverage that you can purchase to help cover the costs of your prescriptions. You’re eligible to purchase a plan if you have Medicare coverage.
You have two ways to get drug plan coverage. The first is to add a drug plan to Original Medicare ( Medicare Part A and Part B) or some cost plans, private fee-for-service plans, or a medical savings account plan. The second is through a Medicare Advantage plan, also known as Medicare Part C, or other Medicare health plans. MA plans offer Medicare Part A and Part B coverage and can offer Part D coverage as well as other health benefits.
Keep in mind that if you’re already enrolled in an MA plan with drug coverage and you enroll in a separate drug plan, you’ll be disenrolled from your MA plan and return to Original Medicare coverage.
Extra Help is an assistance program that can help you pay for your drug plan costs (premiums, deductibles, and coinsurance) if you meet certain requirements for income and resources. In 2021 with Extra Help, the copay for drugs maxes out at $3.70 for generic drugs and $9.20 for brand-name drugs. You can call 1 (800) MEDICARE to see if you qualify for the program.
Generally, once you have Medicare eligibility, there is a seven-month Initial Enrollment Period when you can select a Medicare Part D plan.
If you don’t join your chosen drug plan when you’re eligible, you’ll possibly be subject to a late-enrollment penalty that’s added to your premium. You’ll have to pay the penalty for as long as you have the coverage. However, if you receive Extra Help, you won’t be subject to the penalty.
You can learn more about enrollment eligibility and the Open Enrollment Period from the Centers for Medicare & Medicaid Services at cms.gov.
You can expect to pay an additional monthly fee if you have a higher income. The additional fee begins with income over $87,000 for individuals and $174,000 if you’re married and file taxes jointly. The extra fee is between $12.30 and $77.10.
You can have a Medigap policy and drug plan simultaneously, but only if your Medigap plan doesn’t offer drug coverage. Prior to January 1, 2006, some Medigap plans did offer prescription coverage. If you have one of these plans, you need to tell your insurance provider about the additional drug plan. They’ll remove the drug coverage from your Medigap policy. Note that once they take away the drug coverage from your Medigap plan, you can’t get it back.
Prescription drug plans are a great way to cover your prescription drug costs, and they can also help you prepare for future needs. However, since plans are provided by private insurers, it can be difficult to compare premiums, co-pays, other costs, and covered drugs from multiple providers.
Depending on your income and other requirements, you might be eligible for the Extra Help program. Alternatively, if you’re a high-income earner, you could be subject to an extra fee in addition to the cost of your drug plan.
Take the guesswork out of determining plan costs and comparing plan options in your service area. Get started today with the Insurify Medicare comparison tool.
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