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Medicare Prescription Drug Plans

A Medicare Part D plan helps cover the cost of prescription medications and is offered by private insurance companies approved by Medicare. You can get this coverage through a standalone drug plan or as part of most Medicare Advantage plans.

Medicare Prescription Drug Plans – PDP in Maryland

Medicare requires that Medicare eligible consumers have drug coverage, either through a Medicare approved insurance carrier, or other creditable coverage through an employer or union plan. The creditable coverage must be as good as or better coverage than what Medicare offers. If it is not, you will typically receive a letter from Medicare explaining your options. If you don’t obtain coverage, you will start accruing financial penalties.

Always shop around, even internationally. We offer a "white glove" pharmacy-to-door service.  We work with a well established, US-based company in Florida the can buy medications from certified pharmacies in Canada. View our "Secret" Canadian Drug Price List Here >>>

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You Must Have Prescription Drug Coverage Even If You Don't Currently Take Medications

Prescription Drug Plans were first introduced as mandatory coverage for those on Medicare in 2006.

PENALTIES: The penalty for not having drug coverage is 1% of the national average monthly premium. So if the national average monthly premium (as an example) is $35.00 and you miss 12 months of coverage, your MONTHLY penalty removed from your Social Security check will be $4.20 for as long as you have part D coverage  [$35 x .01 = .35 x 12 = $4.20]. However, only the Centers for Medicare & Medicaid are able to determine this penalty (the example shown is for educational purposes only).

Almost all Prescription Drug Plans work with both Mail order pharmacies and Retail store pharmacies and you can mix and match how you receive your medications. Certain medications that require refrigeration or are opioids cannot be purchased through mail order. Almost all the major pharmacies in Maryland will work with your plan, while some offer greater discounts depending on their relationship with the insurance carrier.

Those pharmacies that are considered “Preferred Pharmacies” will offer you the best prices while pharmacies not on your insurance carrier’s “preferred” list will not. So you can save some money by changing your shopping habits.  Learn more about how to reduce Medicare drug costs.

Costs of Medicare Prescription Drug Plans vary greatly, so it’s best to work with a Medicare Insurance broker to determine which carrier and which plan offers you the best savings on your current medications.

All medications  are placed into what the industry calls Tiers and this determines the price you pay. Tier 1 is typically generic medications, like Atorvastatin. Tier 2 medications are a bit more expensive than Tier 2.  Tier 3 medications are normally Brand name medications like Lipitor (which has a generic equivalent called Atorvastatin). Tier 4 medications are even more expensive and depending on the company, Tier 4 and Tier 5 can include injectables (such as insulin) either injected by the consumer or initiated at a medical facility on regular intervals (such as cancer treatments). Medications can be on different Tiers from company to company, and from plan to plan. These plans often change each year.

maryland medicare drug costs

SAVINGS TIP:  As a Medicare beneficiary, you can call the insurance carrier and ask that your expensive Tier 3 or Tier 4 medication be dropped down to a lower Tier so you can afford to purchase it. These request are made directly with the insurance carrier and can help lower your copayment.

2027 Maryland Drug Plan Pricing

How Do Medicare 2027 PDP Plans Work?

There are several stages to having Medicare drug coverage as seen above. Stage 1 is the deductible stage where you must personally spend $700 out of your own pocket prior to the insurance carrier helping with any of the costs. Once this is spent, you then move to Stage 2.

In Stage 2, you are essentially paying 25% of the retail cost of the medication until you've spent $2,400 in copayments and deductibles combined. Then you move to Stage 3.

In Stage 3 is known as the "catastrophic coverage" stage where all of your meds, no matter how expensive, are 100% covered at no cost to you.  You still must pay your prescription drug plan monthly premium and costs for medications that are not covered by your plan.

You can easily determine what your costs will be for the coming year by entering your drug list, milligrams and how often you take your medications at Medicare.gov. It's a free service.

What If I Can't Afford My Medications?

I can still help you enroll into a plan. But first, you should apply for a Low Income Subsidy (LIS) from Social Security. It's easy to do here.  Medicare Part D Low Income Subsidy Application Page

If your income is too high to qualify for the LIS levels, you can apply for Maryland's SPDAP program. You may be eligible if your income is below $47,880 for a single person and $64,920 for a two-person household.  Receive up to $100 per month towards the purchase of a Medicare Part D plan or any portion of a Medicare Advantage Plan's premium that has been designated to cover the Part D portion of the plan.

To apply simply call SPDAP at 1-800-551-5995 or go to http://marylandspdap.com/.  SPAP programs vary by state and by year.

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