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Medicare Prescription Drug Plans in Arizona

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Arizona Medicare beneficiaries can get prescription drug coverage through the Medicare Part D program. Depending on where in Arizona you live, you might have your choice of several Medicare plans that include prescription drug coverage. Availability and costs of such plans in Arizona may vary, but usually you can expect to pay certain costs such as coinsurance or copayments; some plans might charge monthly premium and/or annual deductible amounts.

How Medicare prescription drug coverage works in Arizona

Medicare offers optional prescription drug coverage through private insurance companies that contract with Medicare under the Medicare Part D program. This coverage is designed to help Medicare beneficiaries cover prescription medication costs. If you have Original Medicare (Part A or Part B) coverage, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan; Part A and Part B usually don’t cover prescription drugs except in certain situations such as inpatient hospital stays.

Formularies

Each Arizona Medicare plan that includes prescription drug coverage has its own list of covered prescription drugs. This list is called a formulary, and it places all covered drugs in different tiers (categories), each with a different cost. In general, prescription drugs in the lowest tier have lower costs, while drugs in the higher tier will be priced higher. If your doctor believes that a higher-tier drug is necessary to treat your health condition, you can ask your plan for a tiering exception to have a lower copayment for that drug.

Medicare plans that include prescription drug coverage in Arizona (as in all states) typically include both brand-name and generic prescription drugs in their formularies. Generic drugs, according to the Food and Drug Administration, are safe copies of brand-name drugs that use similar active ingredients and offer similar results. The difference is that generic drugs typically cost less than brand-name drugs and result in lower out-of-pocket expenses for Medicare beneficiaries. In certain cases, the generic version of your brand-name prescription drug may not be available, but a similar generic drug that could work just as well for you may be covered. Be sure to discuss all such generic drug options with your doctor or health care provider.

A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

Eligibility and enrollment

Here are the facts about whether and when you can sign up for in a Medicare plan that includes prescription drug coverage:

  • You can enroll when you’re first eligible for Medicare, during your seven-month Medicare Initial Enrollment Period.
  • If you’re enrolled in Medicare due to a disability, you can generally enroll in Medicare prescription drug coverage during your seven-month IEP, starting three months before your 25th month of collecting disability benefits.
  • In Arizona, as in other states, you can also enroll during the Annual Election Period, which runs from October 15 to December 7. You can also change from one Medicare plan to another during this period.
  • To sign up for a stand-alone Medicare Part D Prescription Drug Plan, you must have (or be eligible for) Medicare Part A(hospital insurance) and/or Medicare Part B (medical insurance).
  • To sign up for a Medicare Advantage Prescription Drug plan, you must have (or be eligible for) both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
  • You must permanently reside in the service area of your plan.
  • If you’re enrolled in a Medicare Advantage plan and decide to switch back to Original Medicare, you can do so during the Medicare Advantage Open Enrollment Period, from January 1 to March 31 each year. In Arizona, as in other states, you can add a stand-alone Medicare Part D Prescription Drug Plan during that time, if you dropped your Medicare Advantage Prescription Drug plan.

Understand that you might be subject to a late enrollment penalty for Medicare Part D, if you don’t sign up during your IEP and don’t have creditable drug coverage for 63 days or more. (Creditable drug coverage is insurance that pays, on average, at least as much as Medicare drug coverage is expected to pay.) In Arizona, as in other states, Medicare calculates the penalty by multiplying 1% of the national base beneficiary premium ($32.74 in 2020) by the number of months you were eligible for Medicare prescription drug coverage but didn’t enroll. Remember that the national base beneficiary premium may increase each year, which means your late enrollment penalty may also go up.

It’s important for you to know that if you choose to enroll in a Medicare plan that includes prescription drug coverage in Arizona (as in other states), you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium to keep your Medicare health coverage.

Types of Medicare prescription drug coverage in Arizona

You can get Medicare prescription drug (Part D) benefits two different ways:

  • A stand-alone Medicare Part D Prescription Drug Plan, for which you’ll pay the plan’s premium (if there is one) in addition to your Original Medicare premium(s).
  • A Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage into one insurance plan. Besides prescription drug coverage, these plans include the same coverage as Original Medicare (Part A and Part B), except for hospice care, which Part A provides. Some plans offer additional benefits such as routine vision, hearing, and dental services, all in one plan. You still need to pay your Part B premium.

Things to consider when deciding on a Medicare plan

Here’s a list of some factors to help guide you when you research Medicare plans that include prescription drug coverage.

  • Make a list of your current medications. If you decide to get a stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan, make sure the plan covers them.
  • Do you anticipate needing more medications in the future? It’s hard to predict such things, but if you can, try to take these needs into consideration. Remember that you could face a late-enrollment penalty if you add this coverage later.
  • How well does the plan cover the Medicare Part D coverage gap (or “donut hole”), where beneficiaries’ drug costs can go up significantly?
  • If you already have Medicare prescription drug benefits, you may want to review your policy at the end of the year to keep up with any important changes. In Arizona, as in other states, Medicare plans that include prescription drug coverage are allowed to change their premiums, copayments, deductibles, and drug formularies every year, so your current plan may not be the one best suited to your health needs the following year.

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.