Understanding Medicare Part D in New York
As we grow older, access to reliable and affordable medications becomes increasingly important to maintain your health. In this article, we’ll walk you through everything you need to know about Medicare Part D coverage in New York, including how they work, how much they cost, which insurance companies provide drug plans in the state, and more. Read on to find a drug plan that works for the medications you need.
Key takeaways:
In 2024, there are 15 Medicare Part D plans in New York and five insurance providers that offer them.
Wellcare Value Script is the lowest-cost prescription drug plan with the highest Medicare star rating of plans available in New York.
The average monthly price of a drug plan in New York is $64.
If you need help finding a Part D plan in New York that covers your prescription drugs at an affordable price, Chapter Medicare Advisors are here for you.
What is Medicare Part D?
Medicare Part D is Medicare’s prescription drug coverage. Part D is one component of your overall health coverage. Private insurance companies contract with Medicare to provide these drug plans, and each plan is different. This means your costs can vary with insurance providers.
You can enroll in Medicare Part D through a standalone plan or bundled with a Medicare Advantage plan. If you have a low income and low resources or qualify for any Medicare Savings Programs, the Medicare Extra Help program can cover your drug plan premiums and deductibles. Your copayments and coinsurance will also be reduced.
On the other hand, if you have a higher income, you may have to pay an IRMAA surcharge on top of your monthly Part D premium.
There’s a lot to learn about Medicare Part D—read more to learn everything you need to know to choose the right coverage.
What are formularies and drug tiers?
There are two terms you should understand when looking for Medicare prescription drug coverage in New York: formulary and tier. Your formulary is a list of drugs that your plan covers. Your formulary will also have drug tiers. Each medication is on a “drug tier.” Depending on which tier a certain drug is on, your costs for the drug may be higher or lower. Drugs on Tier 1 and Tier 2 are low-cost, generic drugs. Drugs on Tiers 3-4 are more expensive, brand-name medications. Tier 5 drugs are the most expensive, and are considered premium drugs. Some plans have additional tiers. The general rule of thumb is: the higher the tier, the higher the cost.
Understanding a plan’s formulary and knowing what tiers your regular medications fall under can help you find the most cost-effective plan in New York. More on that soon.
When to enroll in a prescription drug plan
While enrolling in a Medicare drug plan is optional, you can face penalties for signing up late. The best time to enroll in Part D is during your Initial Enrollment Period, which is a 7-month window around your 65th birthday. You can also sign up during the Medicare Open Enrollment Period, which occurs from October 15th to December 7th of each year.
Keep in mind, however, that If you don’t sign up during your Initial Enrollment Period and go 63 days without having Part D or other creditable drug coverage, you may face penalty fees on top of your monthly premium. Avoid Medicare penalties by making sure you enroll in Part D at the right time.
Overview of Medicare Part D plans in New York
Over 1.3 million Medicare beneficiaries have enrolled in a prescription drug plan in New York. That’s about 33% of Medicare-eligible people in the state. In this section, we’ll cover star ratings for drug plans in New York, how much Part D costs, and which insurance providers offer plans.
CMS star ratings for Part D plans in New York
Every year, the Centers for Medicare and Medicaid services judges the quality of prescription drug plans to ensure that members know how they perform before enrolling. Currently, five insurance carriers offer 15 prescription drug plans in New York. Of those 15 plans, no plan received 4 or 5 stars, and 1 plan (Wellcare Value Script) received 3.5 stars. The average star rating in 2024 for Part D plans was 3.11, so Wellcare Value Script performed higher than the industry average.
Medicare star ratings aren’t everything—finding a plan that covers your medications at a price that looks good to you is the most important.
How much do Medicare Part D plans cost in New York?
Wellcare has the lowest cost plan at $3.70 per month, and Humana has the highest cost plan at $135.40. Keep in mind that your costs for prescription should also come into consideration. Plans have varying copay and coinsurance amounts for drugs in different tiers. It’s worth noting that Wellcare Value Script is the lowest cost plan with the highest CMS star rating across available plans in New York.
Which insurance providers offer prescription drug plans in New York?
As we mentioned above, you can choose from 15 Part D plans in New York, which is lower than the national average of about 21 plans. These are the five insurance providers that carry drug plans in the state:
WellCare
Cigna
Aetna Medicare
Humana
UnitedHealthcare
Between researching the cost of plans to choosing the right carrier, enrolling in Part D can be tough. We’ll share some tips on how to make the process a little easier below.
What about Medicare Advantage prescription drug plans (MAPDs)?
Many people choose to get drug coverage through a Medicare Advantage plan that includes a prescription drug plan. It’s important to get an overall understanding of Medicare Advantage plans in New York before you settle on an MAPD. While drug premiums tend to be cheaper with MAPDs, you’ll also have to factor in costs of the whole plan, including premiums, deductibles, copays, and coinsurance. These costs can vary between plans, which can make the process of finding a plan even more difficult. Check out our New York Medicare guide for detailed information to help you explore your options.
How to find the right Part D plan in New York
When finding the right prescription drug plan in New York, first start with the medications you take on a regular basis. Write them all down. Then, make a note of your local pharmacy. Some drug plans have preferred retailers, so you may pay extra if you pick up your medications outside of a preferred retailer.
Once you have a list of your medications and pharmacies in front of you, plug them into Medicare.gov’s plan finder tool. You can see all the plans available to you using this tool and how much you’d have to pay for your specific drugs. Pay attention to two key things on this list: the cost of plans and how much you’ll have to pay for your prescriptions.
You can compare plan details on your own, but Medicare.gov doesn’t always have all of the plan details. Furthermore, if you take multiple prescriptions, trying to determine your total estimated costs for your plan and prescriptions can be challenging. Talking to a Chapter Medicare Advisor can simplify the process, because we can compare your costs across all plans in minutes. Get in touch with us today at 855-900-2427 or schedule a time to chat to make Medicare easy.