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.

The Changing of Medicare Part D
This is Part of the Inflation Reduction Act of 2023

What will it Mean for You?
Whether you have Medicare Part D as part of Your Medicare Advantage Plan with Drugs( MAPD)
or You have Medicare Part D as a Seperate Part (Standalone) you will need to be aware of these upcoming changes and
the Restructuring of Medicare Part D
These changes will go into effect January 2025
You will need to make changes  if needed during the 2024 Fall Annual Enrollment Period (October 15th thru December 7th)

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$2,000 cap on out-of-pocket costs for drugs covered by your Medicare plan

New in 2025, your out-of-pocket costs for covered drugs are capped at $2,000. The cap only applies to drugs covered by your Part D plan, so review your plan to make sure your drugs are covered.​
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Having an Issue with Paying for the Cost of a High Priced Drug?
The Medicare Prescription Payment Plan for 2025 can Help.
Read about it below...
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Whats the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan is a new payment option in the prescription
drug law that works with your current drug coverage to help you manage your out-of-
pocket Medicare Part D drug costs by spreading them across the calendar year
(January-December).
Starting in 2025, anyone with a Medicare drug plan or Medicare
health plan with drug coverage (like a Medicare Advantage Plan with drug coverage)
can use this payment option. All plans offer this payment option and participation is
voluntary.
If you select this payment option, each month you’ll continue to pay your plan premium
(if you have one), and you’ll get a bill from your health or drug plan to pay for your
prescription drugs (instead of paying the pharmacy). There’s no cost to participate in
the Medicare Prescription Payment Plan.



(Click on the Picture of the Fact Sheet to Download the Overview)


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.)
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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 2025, no Medicare drug plan may have a deductible higher than $590

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 2025 the “Coverage Gap" is Eliminated 

New for 2025: $2,000 cap on covered Part D drugs
Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. If your out-of-pocket spending on covered drugs reaches $2,000 (including certain payments made on your behalf, like through the Extra Help program), you’ll automatically get “catastrophic coverage.” That means you won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year. 

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 $2,000 in out-of-pocket costs in 2025. This means that you automatically qualify for catastrophic coverage. Catastrophic coverage ensures that you’ll will pay little to no copayment for  your drugs for the rest of the year

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What is the Medicare Part D Late Enrollment Penalty?
The Medicare Part D late enrollment penalty is a surcharge added to your Medicare Part D (prescription drug plan) monthly premium. Medicare gives this penalty to people who don’t sign up for Part D drug coverage before Medicare enrollment period deadlines. It’s not a 1-time fee, and in most cases, it’s permanent.

Three Ways to Avoid the Part D
Late Enrollment Penalty

  1. Enroll in Medicare drug coverage when you’re first eligible—You won’t pay any penalties if you sign up for Medicare Part D coverage during your Initial Enrollment Period (IEP). Your IEP is when you can first sign up for Part A (Hospital Insurance) and Part B (Medical Insurance), and it starts 3 months before you turn 65 and ends 3 months after the month you turn 65.
  2. Don’t go 63 days or more without a drug plan—If you had and lost drug coverage from a creditable provider (current or former employer, TRICARE, individual health insurance coverage, etc.) you must join a new Medicare Part D drug plan in fewer than 63 days. If not, you may pay a penalty if you sign up for Medicare drug coverage after 63 days.
  3. Keep records of your prior drug coverage—When you join a new drug plan, you’ll need proof of your previous creditable prescription drug coverage to avoid a penalty. Your records can also prove it’s been fewer than 63 days since you’ve been covered.





How much more will I pay for a
Late Enrollment Penalty?
The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage.
Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($36.78 in 2025) by the number of full, uncovered months that you were eligible but didn’t enroll in Medicare drug coverage and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year. After you enroll in Medicare drug coverage, the plan will tell you if you owe a penalty and what your premium will be.


Ways to get Help with Prescription Drug Costs

You may find it necessary to get help paying for prescriptions even after enrolling in Medicare drug coverage (Part D)
 

Here are some tips to consider if you think you might need to get help with the costs of prescription drug coverage.

1. Consider switching to generics or other lower-cost drugs.
There may be generic or less-expensive brand-name drugs that would work just as well as the ones you're taking now. Talk to your doctor to find out if these are an option for you. You might also be able to lower prescription costs by using mail-order pharmacies.

2. Pharmaceutical Assistance Programs. 
Some pharmaceutical companies offer programs to help pay for medications for people enrolled in Medicare drug coverage (Part D). Find out whether there’s a Pharmaceutical Assistance Program that can lower prescription costs for the drugs you take.

3. State Pharmaceutical Assistance Programs.
Many states and the U.S. Virgin Islands offer help paying for prescriptions, drug plan premiums and/or other drug costs. Find out if your state has a State Pharmaceutical Assistance Program.
 
4. Apply for Extra Help.
Medicare and Social Security have a program called Extra Help—a way for people with limited income and resources to get help with prescription costs. If you qualify for Extra Help, you could pay no more than:
  • $4.90 for each generic covered drug in 2025
  • $12.15 for each brand-name covered drug in 2025

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
(702) 403-6348
Las Vegas, NV 89134​
Calling the above number will direct an individual
  to a licensed agent/broker
 ​(All calls are recorded for Quality Control)

YOUR GUIDE to
MEDICARE DRUG COVERAGE
 (MEDICARE PART D from CMS Medicare)

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Click on the Picture or this Link to Download
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​Help with Drugs Costs in Las Vegas
How to Get "Extra Help"
Paying for Prescriptions
What is Extra Help?
(Click on the Picture below to Learn More)
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Prescription Plans Change every Year!
Drug Copays go up and Down.
Contact Us or Fill out a Form to get
​ "Your Yearly Part D Drug Plan Review"
CLICK on the FACT SHEET to find out more about EXTRA HELP

​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.

Visit our Enrollment page for Additonal Information on General Enrollment Questions
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