Medicare Part D Plans in Pennsylvania: What You Need to Know
Medicare Part D can seem confusing at first, but if you focus on finding a plan that covers your prescriptions and get help calculating your total costs, choosing the right plan can be a breeze. In this guide, we’ll walk you through everything you need to know about Medicare Part D and how to find the best Pennsylvania Part D coverage for your needs.
Key takeaways:
Medicare Part D provides prescription drug coverage. You can choose between a standalone prescription drug plan or a Medicare Advantage plan that includes Part D coverage.
In Pennsylvania, there are 20 prescription drug plans offered by seven insurance carriers.
The average cost of standalone Part D plans is $41.18.
When choosing drug coverage in Pennsylvania, you should focus on making sure your plan covers your prescriptions at a low cost.
Medicare Part D explained
Original Medicare (Part A & Part B) doesn’t provide prescription drug coverage. Part A and Part B cover medical and hospital services. Medicare Part D, an optional add on, provides prescription drug coverage.
You have two options for Medicare Part D coverage. You can get either a standalone prescription drug plan or a Medicare Advantage plan that includes drug coverage. The vast majority of Medicare Advantage plans provide Part D coverage. If you’re enrolled in a Medicare Advantage plan that doesn’t cover prescriptions, you can enroll in a standalone Part D plan.
With Medicare Part D, you’ll owe a monthly premium. With a Medicare Advantage plan, this premium is included in your Medicare Advantage premium. $0 Medicare Advantage premiums are common, but keep in mind that you do still have to pay any applicable Original Medicare premiums and IRMAA surcharges if you enroll in Medicare Advantage.
LEARN >> What is Medicare IRMAA?
Premiums aren’t the only costs you should consider when comparing Part D options. You should also look at each plan’s covered drugs, deductible, copays, and coinsurance amounts to determine your total costs for your plan and prescriptions.
Note that Part D and Medicare Advantage plans can change each year, so it’s always a good idea to review your options during the Medicare Open Enrollment Period. Whether you’re just getting started with Medicare or want to change plans, our licensed Advisors are happy to help you go over your options for drug coverage and check if there's a better plan out there for you.
Finding the right coverage for your prescription needs
There are a two key things to pay attention to when looking for prescription drug coverage:
The plan’s formulary, or list of drugs that it covers
The copay and coinsurance amounts for your prescriptions
Your biggest priority should be finding a drug plan that covers your prescriptions. It can be helpful to write all your regular medications down to get a sense of what you might pay with different drug plan options. To make things easier, also note the dosage and frequency for each prescription you take.
Your Part D coverage may have preferred pharmacies, at which you’ll pay reduced costs. You’ll also want to make sure that you’re able to go to a plan’s preferred pharmacies to get the best price for your prescriptions. When you know your medications and your local pharmacies, the choice for your drug coverage becomes easier. For example, if your preferred pharmacy is CVS and you take lisinopril regularly, an Aetna SilverScript drug plan may be the best option for you. This is just one example. You should always compare all the plans available to you and their preferred pharmacies to
Medicare Part D in Pennsylvania: insurance carriers, costs, and plans
Medicare’s plan finder tool is a good resource to start comparing drug coverage in Pennsylvania. Below is a summary of the Part D plans available in Pennsylvania. To quickly compare all plans with your specific needs in mind, give us a call at 855-900-2427.
Insurance carriers that offer prescription drug plans in Pennsylvania
There are 20 prescription drug plans in Pennsylvania, which is about the same as the national average of 21. A total of seven insurance providers offer prescription drug plans in Pennsylvania, including:
Aetna Medicare
Cigna
Highmark Blue Shield
Humana
Mutual of Omaha Rx
UnitedHealthcare
Wellcare
Star ratings for Medicare prescription drug plans in Pennsylvania
Medicare star ratings aren’t everything. In fact, there could be plans that reduce your costs for prescriptions but have a low star rating. Still, it can be helpful to know which plans received a lower or higher score as a point of comparison.
Each year, Medicare gives every Part D plan a rating out of five stars. A 1-star rating is the lowest score and a 5-star rating is the highest score. For 2024, no Part D plans received 4 or 5 stars in Pennsylvania. This isn’t abnormal, and the national average is 3.11 stars for all drug plans.
Six Oregon Part D plans received a star rating of 3.5:
Wellcare prescription drug plans (Wellcare Classic, Wellcare Value Script, and Wellcare Medicare Rx Value Plus)
AARP Medicare Rx Preferred from UHC (PDP)
Highmark Blue Shield prescription drug plans (Blue Rx PDP Plus and Blue Rx PDP Complete)
If you’re looking at Pennsylvania Medicare Advantage plans, make sure to evaluate the cost of the plan and your drug costs before enrolling. You should also make sure you understand the pros and cons of Medicare Advantage plans vs Original Medicare.
Cost of prescription drug plans in Pennsylvania
The lowest cost option for prescription drug plans in Pennsylvania is Wellcare Value Script, which has a monthly premium of $0.50. The highest cost option is Blue Rx PDP Complete from Highmark Blue Shield, which has a monthly premium of $195.10.
Premiums aren’t your only cost. Pay attention to Part D deductibles and copay and coinsurance amounts for your prescriptions. It may make sense to have a drug plan with a higher premium if you end up saving more on your out-of-pocket costs.
Enrolling in Part D in Pennsylvania
If you’re new to Medicare, the best time to enroll in Part D is during your Initial Enrollment Period. If your plan changes or your needs change, you can switch your drug plan during the annual Open Enrollment Period, which occurs from October 15th to December 7th every year.
Take a look at our Medicare Pennsylvania Guide for other insights into your Medicare coverage. Still have questions? We’re happy to help! Call us at 855-900-2427 or schedule a time to chat for all your Medicare needs.