Medicare Part D: Complete Guide to Prescription Drug Coverage
Medicare Part D provides prescription drug coverage that can save you thousands of dollars annually. This comprehensive guide explains how Part D works, what it costs, how to choose the best plan in Nevada, and strategies to minimize your prescription drug expenses.
Key Part D Facts for 2024
- 27 standalone Part D plans available in Nevada
- Premiums range from $7.90 to $200+ per month
- Coverage gap (donut hole) closes at $8,000 out-of-pocket
- Late enrollment penalty: 1% per month without coverage
In This Guide
What is Medicare Part D?
Part D Basics
- Voluntary prescription drug coverage
- Available as standalone plans or part of Medicare Advantage
- Run by private insurance companies
- Each plan has its own formulary (drug list)
- Can change plans annually during AEP
Who Needs Part D?
You SHOULD Enroll If:
- • You take any prescription medications
- • You might need prescriptions in the future
- • You want to avoid late enrollment penalties
- • You don't have other creditable drug coverage
You MAY Skip If:
- • You have creditable coverage (VA, TRICARE, employer)
- • You truly take no medications and have low income
- • You're enrolled in a Medicare Advantage plan with drug coverage
Important: Late Enrollment Penalty
If you don't enroll in Part D when first eligible and don't have creditable coverage, you'll pay a penalty of 1% of the national base premium ($34.70 in 2024) for each month you were late.
Example:
25 months late = 25% × $34.70 = $8.68/month penalty FOR LIFE
How Part D Coverage Works: The Four Phases
Part D coverage works in phases based on how much you and your plan spend on drugs each year. Understanding these phases helps you predict your costs.
Deductible Phase
You pay 100% of drug costs
When:
Until you've paid up to $545
You Pay:
100% of drug costs
Initial Coverage Phase
You pay copays/coinsurance
When:
Until total drug costs reach $5,030
You Pay:
Plan's copay/coinsurance
Coverage Gap (Donut Hole)
You pay 25% of drug costs
When:
Until you've spent $8,000 out-of-pocket
You Pay:
25% for generics and brand drugs
Catastrophic Coverage
Very low costs for rest of year
When:
After $8,000 out-of-pocket
You Pay:
5% or $4.15/$10.35 copay
2024 Coverage Gap (Donut Hole) Changes
- • You now pay 25% for both generic and brand-name drugs (down from previous years)
- • Manufacturer discounts on brand drugs count toward your out-of-pocket spending
- • The coverage gap effectively closes at $8,000 out-of-pocket (True Out-of-Pocket or TrOOP)
- • Most people never reach the coverage gap - average Part D spending is about $1,200/year
Part D Costs: What You'll Pay in 2024
Monthly Premium
$55.50
National average
- • Nevada range: $7.90 - $200+
- • Higher income pays more (IRMAA)
- • Some plans have $0 premium
Annual Deductible
$545
Maximum for 2024
- • Many plans have $0 deductible
- • Some cover generics before deductible
- • Higher premium = lower deductible
Copays/Coinsurance
Varies
By drug tier
- • Generics: $0-25 typically
- • Brand drugs: $47-200+
- • Specialty: 33% coinsurance
High-Income Surcharges (IRMAA) for Part D
If your income exceeds certain levels, you'll pay an additional monthly amount on top of your plan premium:
| 2022 Income (Individual/Joint) | Monthly Surcharge | Example Total* |
|---|---|---|
| $103,000-129,000 / $206,000-258,000 | +$12.90 | $68.40 |
| $129,000-161,000 / $258,000-322,000 | +$33.30 | $88.80 |
| $161,000-500,000 / $322,000-750,000 | +$53.80 | $109.30 |
| $500,000+ / $750,000+ | +$74.20 | $129.70 |
*Example assumes $55.50 average plan premium
Annual Cost Examples for Nevada Seniors
Low Drug Use (1-2 generics)
- • Plan premium: $95-300/year
- • Drug costs: $120-480/year
- • Total: $215-780/year
High Drug Use (Multiple brands)
- • Plan premium: $300-600/year
- • Drug costs: $2,000-8,000+/year
- • Total: $2,300-8,600+/year
Part D Plans Available in Nevada (2024)
Humana
Plans Available: 8
Premium Range: $7.90 - $147.60
Popular Plan: Humana Basic Rx Plan
Strengths:
- Low premiums
- Good generic coverage
- Wide pharmacy network
Aetna (CVS Health)
Plans Available: 4
Premium Range: $8.50 - $89.40
Popular Plan: Aetna Medicare Rx Saver
Strengths:
- CVS pharmacy integration
- Mail order benefits
- Competitive pricing
Anthem
Plans Available: 3
Premium Range: $12.30 - $76.20
Popular Plan: Anthem MediBlue Rx Plus
Strengths:
- Regional focus
- Good customer service
- Comprehensive formulary
WellCare
Plans Available: 5
Premium Range: $9.80 - $134.70
Popular Plan: WellCare Value Script
Strengths:
- Medicare focus
- Extra benefits
- Prescription savings
Nevada-Specific Considerations
- • Rural Nevada may have fewer pharmacy options - check network carefully
- • Las Vegas and Reno have all major pharmacy chains in most networks
- • Consider mail-order for maintenance medications
- • Some plans offer preferred pharmacy networks with lower copays
- • Nevada has no state pharmacy assistance program currently
Understanding Formularies & Drug Tiers
What is a Formulary?
A formulary is the list of prescription drugs covered by a Part D plan. Each plan has its own formulary, and drugs are placed into different "tiers" with different costs.
Tier 1
Preferred Generic
$0-15
Lowest cost generic drugs
Tier 2
Generic
$5-25
Most generic drugs
Tier 3
Preferred Brand
$47-95
Brand drugs with generic alternatives
Tier 4
Non-Preferred Brand
$100-200
Higher-cost brand drugs
Tier 5
Specialty
33% coinsurance
Very expensive specialty drugs
Common Medications & Typical Costs
Heart/Blood Pressure
$15-45Common drugs: Lisinopril, Metoprolol, Amlodipine, Atorvastatin
Generic available: Yes
Diabetes
$25-400Common drugs: Metformin, Insulin, Jardiance, Januvia
Generic available: Mixed
Arthritis/Pain
$20-150Common drugs: Celebrex, Meloxicam, Tramadol, Gabapentin
Generic available: Yes
Mental Health
$10-200Common drugs: Sertraline, Escitalopram, Quetiapine, Aripiprazole
Generic available: Mixed
Blood Thinners
$10-500Common drugs: Warfarin, Eliquis, Xarelto, Pradaxa
Generic available: Limited
Formulary Tips
- Check your drugs before enrolling
- Look for generic alternatives
- Consider therapeutic alternatives
- Review formulary changes annually
Watch Out For
- Prior authorization requirements
- Step therapy (try cheaper drug first)
- Quantity limits
- Drugs moving to higher tiers
How to Choose the Right Part D Plan
Step-by-Step Plan Selection Process
- 1List your medications: Include drug name, dosage, and quantity per month
- 2Use Medicare Plan Finder: Go to Medicare.gov and enter your drugs
- 3Compare total annual costs: Premium + deductible + estimated drug costs
- 4Check pharmacy networks: Ensure your preferred pharmacy is included
- 5Review plan ratings: Look at customer satisfaction and performance
Your Medications
Critical- Check if all your drugs are covered
- Verify correct dosages and quantities
- Look for prior authorization requirements
- Consider generic alternatives
Total Annual Cost
High- Add premium + deductible + copays
- Use Medicare Plan Finder calculator
- Consider coverage gap costs
- Factor in pharmacy costs
Pharmacy Network
High- Check if your pharmacy is in-network
- Consider mail-order options
- Look for 90-day supply savings
- Verify specialty pharmacy access
Plan Ratings
Medium- Check Medicare's star ratings
- Read customer reviews
- Consider customer service quality
- Look at formulary stability
Extra Help Program (Low Income Subsidy)
What is Extra Help?
Extra Help is a federal program that helps pay for Medicare Part D costs if you have limited income and resources. It can save you thousands of dollars per year and allows you to change plans more often.
Extra Help Benefits by Income Level (2024)
| Income Level | Asset Limit | Premium | Deductible | Copays |
|---|---|---|---|---|
| 100% of Federal Poverty Level | $9,090 (individual) / $14,070 (couple) | $0 | $0 | $0 |
| 135% of Federal Poverty Level | $15,510 (individual) / $30,950 (couple) | $0 | $0 | $4.50/$11.20 |
| 150% of Federal Poverty Level | $15,510 (individual) / $30,950 (couple) | Sliding scale | $0 | $4.50/$11.20 |
How to Apply in Nevada
- • Apply online at Social Security.gov
- • Call Social Security: 1-800-772-1213
- • Visit local Social Security office
- • Apply through Nevada Medicaid office
- • Get help from Nevada SHIP: 1-800-307-4444
Extra Help Benefits
- • No coverage gap (donut hole)
- • Can change plans once per quarter
- • Never pay more than $4.50-$11.20 copay
- • Automatic enrollment in low-cost plans
- • Protected from plan premium increases
Part D Enrollment & Making Changes
When You Can Enroll
- Initial Enrollment: 7 months around your 65th birthday
- Annual Open Enrollment: October 15 - December 7
- Special Enrollment: Certain qualifying events
- Extra Help Recipients: Can change quarterly
How to Enroll
- Online: Medicare.gov (recommended)
- Phone: 1-800-MEDICARE or insurance company
- In-person: Licensed agent or broker
- Mail: Paper application from plan
Important Enrollment Reminders
- • You cannot be enrolled in both a standalone Part D plan and Medicare Advantage with drug coverage
- • If you have employer coverage, check if it's creditable before enrolling
- • Coverage typically starts the first day of the month after you enroll
- • During Annual Open Enrollment, changes take effect January 1
- • Keep documentation of enrollment and any creditable coverage
Get Help Choosing Your Part D Plan
Our licensed Nevada Medicare specialists can analyze your medications and find the Part D plan that will save you the most money.
Get Free Part D Analysis