Medicare Part D
in Las Vegas
Prescription Drug Plans 


​Medicare Part D Can be confusing.
Our Plan Finder tool will look at the Prescriptions you take and find a plan that covers your Meds and has LOW Out-of-Pocket costs.

Medicare Part D ​Prescription Drug Coverage in Las Vegas

Medicare Part D helps cover the cost of prescription drugs. Part D is optional and only provided through private insurance companies approved by the federal government. However, Part D is offered to everyone who qualifies for Medicare. Costs and coverage may vary from plan to plan. There are different ways to get Medicare Part D prescription drug coverage, read on to see what it covers and how it works.

How to get prescription drug coverage?
There are 2 ways to get Medicare Part D prescription drug coverage:
  1. As a standalone prescription drug plan with Medicare: If you have Medicare Part A and Part B (also called Original Medicare), you can add a Part D prescription drug plan to your existing coverage.
  2. As part of a Medicare Advantage plan (Medicare Part C): Medicare Advantage plans include all your Part A and Part B coverage. They may also include prescription drug insurance. Not all Medicare Advantage plans include prescription drug coverage, and you must already have Part A and Part B to qualify for Medicare Advantage. 

What does Medicare Part D Cover in Las Vegas
Medicare Part D plans use a list of approved drugs to decide what’s covered and what isn’t. This list is called a drug formulary. The formulary may differ from plan to plan. Many plans arrange their list of covered drugs in different levels, called “tiers”. Generally, drugs in a lower tier will cost less than drugs in a higher tier. Here an example of a typical Medicare drug plan’s tier system ( remember, your plan may be different):
  • Level or Tier 1: Preferred, low-cost generic drugs
  • Level or Tier 2: Nonpreferred and low-cost generic drugs
  • Level or Tier 3: Preferred brand-name and some higher-cost generic drugs
  • Level or Tier 4: Nonpreferred brand-name drugs and some nonpreferred, highest-cost generic drugs
  • Level or Tier 5: Highest-cost drugs including most specialty medications

What drugs are not covered by Part D?
Some medications may not be covered by your Medicare Part D plan. This can depend on your plan’s formulary.

Medicare Part D restrictions and limitations
Some prescription drug plans may have restrictions on certain medications.
These can include:
  • Prior authorization: Your doctor may need approval from your plan before prescribing some medications. This may be because a drug is only approved for certain conditions, or to ensure that the drug is medically necessary.
  • Step therapy: For some conditions, your plan may require you to try a cheaper drug on your formulary first. If the cheaper medication doesn’t work for your condition or produces bad side effects, you may be able to move up a “step” to a more expensive drug.
  • Quantity limits: Sometimes, plans may limit the amount of medication prescribed over a period of time. This is done for safety reasons, or to cut down on costs.

How much does Medicare Part D Cost in Las Vegas?
Your costs for Medicare Part D consist of several different payments. The exact amount of these costs may vary depending on your plan, what tier level a drug is in or what pharmacy you use. Drugs costs can also depend on whether you use a Standard Pharmacy or a Preferred Pharmacy.
(Hint: You will receive a lower cost for your prescription drug copays if you get them filled at either a Preferred Pharmacy or use the plans Mail-Order Pharmacy.)

Monthly premiums

Standalone Part D Plans
For most prescription drug plans, you will pay a premium, or a monthly fee. This premium is paid in addition to the one you pay for Medicare Part B.

Medicare Advantage Plans (MAPD)
Medicare Part D is included in most Medicare Advantage plans (MAPD).
However if you join an MA only plan it will not include Medicare Part D and you are not able to add a seperate Part D Plan ( standalone.)
​
Additional Monthly adjustment
If your income is above a certain limit, you may pay a monthly adjustment payment in addition to your prescription drug premium whether your plan coverage is a Standalone plan or your coverage is part of your Medicare Advantage Plan.
See  the chart on the Medicare website for an explanation of additional Part D monthly costs by income. (We call this the IRMMA caculation.)

Yearly deductibles
For many plans, you will have to pay a certain amount each year for your prescription drugs before the Medicare drug plan kicks in to cover costs. This amount is called the yearly deductible.
For 2023, no Medicare drug plan may have a deductible higher than $505

Copayments or coinsurance
After you meet your deductible, your plan may require you to pay for part of the cost of your prescriptions.
This amount is called the copayment or coinsurance.
In 2023, once you and your insurance spend a combined total of $4,660 (including your deductible), you will pay no more than 25% of the cost for prescriptions. This 25% cap will continue until your out-of-pocket spending hits $7,400.

Understanding the “Coverage Gap"
For most Medicare prescription plans, there is a temporary limit on what the plan covers. This is called the Coverage Gap. In 2023, this coverage gap will be triggered once you and your plan spend a combined $4,660 on covered medications. Once you’re in the coverage gap, you will pay a maximum of 25% of the cost for Brand-name or Generic drugs in your plan. Although you pay only a fraction of the cost of your prescriptions, almost the full price of the drugs count toward your total out-of-pocket costs. (TROOP)

Catastrophic coverage
After you’ve spent $7,400 in out-of-pocket costs in 2023, you are out of the coverage gap. This means that you automatically qualify for catastrophic coverage. Catastrophic coverage ensures that you’ll pay only a small coinsurance percentage or copayment for drugs covered by your plan until the end of the year.

How to get Extra Help in Las Vegas
Depending on your income, you may qualify for Extra Help. Extra Help is a program that assists those with limited resources in paying for their Medicare prescription drug costs.
You may automatically qualify for Extra Help if you have Medicare and are enrolled in any of the following programs:
  • Full Medicaid coverage
  • Assistance from your state Medicaid program for covering Part B premiums
  • Supplemental Security Income benefits

Enrolling in Medicare Part D in Las Vegas
Typically, if you qualify for Medicare, you qualify for Part D prescription drug coverage. But it’s important to keep in mind that you may enroll in Part D coverage only in a few specific periods:
  • Your Medicare Initial Enrollment Period (IEP): You can enroll in a Part D plan in the 3 months you turn 65, the month of your 65th birthday or 3 months after.
  • The Medicare Annual Enrollment Period (AEP): This runs from Oct. 15 to Dec. 7 every year. During the AEP, you may make changes to your Medicare Part C and Part D coverage. They will take effect on Jan. 1 of the following year.
  • The Medicare Advantage Open Enrollment Period (OEP): This lasts from Jan. 1 to March 31 each year. You may add, drop or change your Part D coverage during this time.
  • Special Enrollment Period (SEP): You may be able to enroll in a new Part D plan if you’re eligible for an SEP. You may qualify for an SEP under certain circumstances, such as if you make changes to a job-based drug coverage plan, or if you have or lose Extra Help.
(702) 403-6348
2524 Settlers Bay Ln
Las Vegas, NV 89134
Calling the above number will direct an individual
  to a licensed agent/broker
 ​(All calls are recorded for Quality Control)

Prescription Plans Change every Year!
Drug Copays go up and Down.
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​ "Your Yearly Part D Drug Plan Review"
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