Medicare Part D Plans in New York

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Medicare Prescription Drug Plans in New York

Original Medicare offers many benefits, but it doesn’t cover prescription drugs. You’ll need to purchase a Medicare Part D plan to help with prescription drug costs or choose a Medicare Advantage Plan with prescription drug coverage.

New York has several options for Medicare Part D plans, some with a low monthly premium. Learn more about New York Medicare Part D prescription drug plans:

  • All New York Medicare recipients have access to a Medicare prescription drug plan in 2022.
  • There are 19 Part D prescription drug plans available in New York in 2022.
  • Seven Part D prescription drug plans in New York participate in the Part D Senior Savings Model, which offers lower out-of-pocket insulin costs than other plans.
  • The lowest 2022 Part D prescription drug plan monthly premium in New York is $7.20.

Read on to learn about enrollment, cost, and benefits of Medicare Part D plans in New York.

Medicare Part D Plans in New York

Compare ratings of New York’s Medicare Part D plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars Fifth out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of 10
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Note: A.M. Best, BBB, NCQA, and J.D. Power ratings assess the insurance company as a whole or Medicare Advantage Plans, which often include prescription drug coverage.

What Medicare Part D Plans Cover

Medicare Part D plans offer prescription drug coverage. Each plan has a formulary, which is the plan’s list of covered drugs. Typically, Part D plans have drug tiers, which indicate the drug’s cost.

Part D Formularies

A Medicare Part D formulary is a list of all the drugs covered by the plan. All Medicare Part D plans are required to cover a wide range of prescription drugs for people with Medicare, with at least two drugs per drug category.

Medicare Part D Formulary Coverage
Drugs Part D plans must cover Drugs in these protected classes:
  • Anticonvulsants
  • Antidepressants
  • Antineoplastics (cancer drugs)
  • Antipsychotics
  • Antiretrovirals (HIV/AIDS drugs)
  • Immunosuppressants
Commercially available vaccines
Generic and brand-name drugs in commonly prescribed categories (such as antibiotics, insulin, and drugs for pain)
Drugs not covered by Part D plans Drugs you don’t self-administer which are covered by Medicare Part B, such as those in an outpatient hospital setting
Cosmetic medications
Cough and cold medications
Over-the-counter drugs
Prescription vitamins or minerals
Weight gain or loss medications
Erectile dysfunction drugs

If your specific drug is not on a plan’s formulary, it should have a similar drug available. You can ask for an exception if you need a drug that’s not on a plan’s formulary.

Part D Tiers

Usually, Medicare Part D plans categorize drugs in tiers, with each tier charging a different copayment amount. For example:

Medicare Part D Tiers
Tier Cost What’s covered
Tier 1 Lowest copayment Most generic prescription drugs
Tier 2 Moderate copayment Preferred brand-name prescription drugs
Tier 3 High copayment Non-preferred brand-name prescription drugs
Tier 4 or 5 (specialty tier) Very high copayment High-cost prescription drugs

Medicare Part D Plan Eligibility and Enrollment

You can enroll in a Medicare Part D prescription drug plan if you’re enrolled in Medicare Part A and/or Part B, or a Medicare Advantage Private Fee-for-Service (PFFS) Plan that doesn’t offer prescription drug coverage. You must be enrolled in Medicare Part A and B to join a Medicare Advantage Plan.

It pays to enroll in prescription drug coverage during your initial enrollment period, even if you don’t take prescription medications. If you don’t enroll during this period and have no creditable drug coverage, you’ll have a 1% penalty for each month you don’t enroll, which will be added to your Part D monthly premium.

Part D enrollment is available during specific enrollment periods:

Medicare Part D Enrollment Periods
Enrollment period When it happens What you can do
Initial Enrollment Period The seven-month period beginning three months before you turn 65 and three months after New enrollment
Annual Enrollment Period October 15 to December Enroll in a new plan, disenroll, or make a one-time switch from one plan to another.
Medicare Advantage Open Enrollment January 1 to March 31 Switch to a different Medicare Advantage Plan with or without drug coverage. Go back to Original Medicare and enroll in a Part D plan.

There are multiple ways to enroll in Medicare Part D prescription drug plans:

  • Enroll on the Medicare Plan Finder or on the plan’s website.
  • Complete a paper enrollment form.
  • Call the plan.
  • Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.

When you join a Medicare drug plan, you’ll give your Medicare Number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

What Medicare Part D Costs in New York

You’ll pay a monthly premium and be subject to an annual deductible and copays for each prescription with a Medicare Part D plan.

  • Lowest Part D monthly premium in New York: $7.20
  • Maximum annual deductible: $480
  • Copays: As low as $0 for preferred generic in the initial coverage phase
Compare your 2022 Medicare Part D plan costs in Albany:
PDP Plan name Monthly premium Deductible Tiers/Initial coverage phase copay/coinsurance Coverage gap phase Catastrophic coverage phase
Aetna Medicare SilverScript SmartRx  $7.20 $480 Preferred generic: $1

Generic: $19

Preferred brand: $46

Non-preferred drug: 49%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

Humana Walmart Value Rx Plan  $25.00 $480 Preferred generic: $0

Generic: $2

Preferred brand: 13%

Non-preferred drug: 45%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

Wellcare Value Script $12.90 $480 Preferred generic: $0

Generic: $4

Preferred brand: $42

Non-preferred drug: 47%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

The initial coverage phase starts when you meet your deductible and ends when you and your plan have spent $4,430. You then enter into the coverage gap phase (also known as the “donut hole”) until your out-of-pocket spending reaches $7,050. You pay a small amount for prescription drugs for the remainder of the year while you are in the catastrophic coverage phase.

If you have limited resources, you may be able to get financial assistance through Medicaid, Extra Help, or Pharmaceutical Assistance Programs in your state.

How to Choose a Medicare Part D Plan in New York

Consider these factors as you compare Medicare prescription drug plans available in your area:
Monthly premium You’ll pay this amount every month whether or not you use your benefits. You should have access to at least one low-cost plan in your area.
Additional costs How much will it cost to use your benefits? Understand your deductible, copayments, and coverage during the gap and catastrophic phases.
Provider network Check to make sure your preferred pharmacies are in network to keep costs as low as possible.
Drug coverage/formulary See if your drugs are on the plan’s formulary and how much they cost each time you fill a prescription. You may want to talk with your doctor about a generic or alternative version of a drug you need.
Plan ratings Consider the quality of the plan based on Medicare star ratings, ratings from independent organizations such as the NCQA (which rates Medicare Advantage Plans that typically include drug coverage), and reviews from plan members.

Medicare Part D Resources in New York

Need help choosing a Part D plan or help paying for your prescription drugs? Counselors in New York can help you find the best Part D coverage for your needs. They can also help if you’re having trouble getting an exception approved or have a denied claim. Get in touch with these Medicare resources in New York:

New York Medicare Resources
New York Area Agencies on Aging Website Find a New York Area Agency on Aging (AAA) through the state’s Office for the Aging website. AAAs provide comprehensive services for older adults. The agencies have programs designed to help seniors 60 and older maintain their health and independence, including resources to guide you through the Medicare enrollment process, and the counselors will help you understand the available benefits fully.
New York State’s Health Insurance Information, Counseling, and Assistance Programs (HIICAP) Website | (800) 701-0501 HIICAP is the state’s trusted source for Medicare information, including guidance for choosing Medicare Advantage plans. Certified counselors offer free, personalized information sessions and they also offer community outreach.
New York Medicare Savings Program Website The Medicare Savings Program (MSP) is a Medicaid-administered program that can assist people with limited income in paying for their Medicare premiums. Depending on your income, the MSP may also pay for other cost-sharing expenses
CMS Region 2 Office Website | [email protected] Contact the CMS regional office in New York for assistance with prescription drug coverage.
Elderly Pharmaceutical Insurance Coverage (EPIC) Program Website | (800) 332-3742 The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 325,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.
NYS Uninsured Care Programs Website | (518) 459-1641 The Uninsured Care Programs provide access to free health care (Drugs, Outpatient Primary Care, Home Care, Insurance Premium Payments, and Pre-Exposure Prophylaxis to prevent HIV infection) for New York State residents who are uninsured or underinsured.
Extra Help Website | 1 (800) 633-4227 Extra Help can offer assistance paying Medicare prescription drug plan costs.
Pharmaceutical Assistance Program Website Enter your prescription drugs to get help paying for them.
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