Medicare Prescription Drug Plans in North Carolina
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.
North Carolina has several options for Medicare Part D plans, some with a low monthly premium. Learn more about North Carolina Medicare Part D prescription drug plans:
- All North Carolina Medicare recipients have access to a Medicare prescription drug plan in 2023.
- There are 19 Part D prescription drug plans available in North Carolina in 2023.
- Seven Part D prescription drug plans in North Carolina participate in the Part D Senior Savings Model, which offers lower out-of-pocket insulin costs than other plans.
- The lowest 2023 Part D prescription drug plan monthly premium in North Carolina is $4.20.
Read on to learn about enrollment, cost, and benefits of Medicare Part D plans in North Carolina.
Medicare Part D Plans in North Carolina
Compare ratings of North Carolina’s Medicare Part D plan providers: | ||||
Insurance company | Medicare rating | A.M. Best rating | BBB rating | J.D. Power ranking |
Aetna | 4 stars | A | A+ | 6th out of 9 |
Anthem Blue Cross Blue Shield | 4 to 4.5 stars | A+ | A+ | 7th out of 9 |
Cigna | 4 stars | A- | Not rated | 8th out of 9 |
Humana | 4 stars | A- | A+ | 2nd out of 9 |
UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
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:
|
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 North Carolina
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 North Carolina: $4.20
- Maximum annual deductible: $505
- Copays: As low as $0 for preferred generic in the initial coverage phase
Compare your Medicare Part D plan costs in Raleigh: | |||||
PDP Plan name | Monthly premium | Deductible | Tiers/Initial coverage phase copay/coinsurance | Coverage gap phase | Catastrophic coverage phase |
Aetna Medicare SilverScript SmartRx | $7.00 | $505 | 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 | $22.70 | $505 | Preferred generic: $1
Generic: $4 Preferred brand: 16% Non-preferred drug: 38% 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 | $505 | 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 $4,660. You then enter into the coverage gap phase (also known as the “donut hole”) until your out-of-pocket spending reaches $7,400. 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 North Carolina
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 North Carolina
Need help choosing a Part D plan or help paying for your prescription drugs? Counselors in North Carolina 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 North Carolina:
North Carolina Medicare Resources | ||
North Carolina Area Agencies on Aging | Website | (800) 662-7030 | Find a North Carolina Area Agency on Aging (AAA) through the state’s Department of Health and human Services. 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. |
North Carolina SHIIP | Website | (855) 408-1212 | SHIIP 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. |
CMS Region 4 Office | Website | [email protected] | Contact the CMS regional office in Atlanta for assistance with prescription drug coverage. |
The North Carolina HIV Medication Assistance Program (NC HMAP) | Website | (919) 546-1714 | NC HMAP is funded jointly by state and federal dollars and is designed to provide financial assistance to low-income state residents for the purchase of medications specifically used to combat HIV and the opportunistic infections which are specific to AIDS. |
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. |
Learn More From Our Sources
- A.M. Best | Health Insurance Industry | Last accessed November 2024
- BBB | Last accessed November 2024
- CMS | Medicare Fact Sheet 2022 | Last accessed November 2024
- J.D. Power 2021 U.S. Medicare Advantage Plan Ratings | Last accessed November 2024
- Medicaid | Last accessed November 2024
- Medicare | Costs for Medicare drug coverage | Last accessed November 2024
- Medicare | Extra Help | Last accessed November 2024
- Medicare | How to get prescription drug coverage | Last accessed November 2024
- Medicare | Joining a Health or Drug Plan | Last accessed November 2024
- Medicare | Part C and D Performance Data | Last accessed November 2024
- Medicare | Pharmaceutical Assistance Programs | Last accessed November 2024
- Medicare | Plan Finder | Last accessed November 2024
- NCQA | Health Plan Ratings | Last accessed November 2024