Choose The Right Prescription Plan For You
Original Medicare doesn’t include drug coverage. In New York, Part D standalone plans or Medicare Advantage plans with prescription drug benefits offer comprehensive medication and vaccine coverage, low copays, competitive premiums, a national pharmacy network, and more.
Standalone Part D Plans
Anthem does not offer standalone Part D prescription drug plans in New York state. Most of our Medicare Advantage plans include Part D prescription drug coverage and additional benefits not found in Original Medicare Part A and Part B.
Learn more about Medicare Advantage plans
All-In-One Plans
You also can purchase a Medicare Advantage (Part C) plan that includes Part D prescription drug benefits, plus hospital, medical, dental, vision, and hearing coverage – all in one plan.
Many prefer Medicare Advantage plus Part D to conveniently manage their healthcare and prescriptions with a single plan.
Smart Tip: If you need financial assistance, check to see if you qualify for Extra Help , a federal program that helps you pay for drug coverage.
Check Prescriptions, Costs, And Pharmacies
Before you enroll, use our tool to look up your prescriptions and their costs. You can customize your search selections to fit your specific needs and find out which pharmacies are nearby.
Avoid A Late Enrollment Penalty
Be sure to consider your Part D enrollment options in New York during your Initial Enrollment Period or when you're first eligible for Medicare. If you don’t have creditable prescription coverage via an employer or another source, you could receive a monthly Part D late enrollment penalty.
Medication Therapy Management
If you’re managing complex medical needs and take multiple medications, you might be eligible for the Medication Therapy Management program. It’s a free program that will help you and your doctor make sure you’re getting the best results from your medications.
Medicare Part D Glossary Of Terms
Here are common terms you may run into when comparing Medicare Part D plans.
You and your doctor have the right to request exceptions set by your drug plan. You can request exceptions from step therapy and quantity limits, or request a lower cost-sharing amount for some drugs.
All drugs covered by your plan are divided into pricing tiers. Generally, generic drugs fall into the lowest tiers and are the most affordable. Brand name and specialty drugs are in higher tiers that cost more.
Most plans have a formulary, which is a list of drugs the plan covers. While there are many drugs Medicare requires Part D plans to cover, you still want a plan that fits your personal prescription needs.
Some drugs, and certain amounts of some drugs, require your doctor to obtain prior approval and submit documentation of medical necessity before they can be covered by your plan.
For safety reasons, your plan may limit the amount of medication you can receive at one time. If your prescription is in excess of safety guidelines or refilled too soon, your doctor may need to contact us for approval.
Step therapy helps keep costs down while ensuring you get effective drugs. For some health conditions, the plan requires you to try a less costly, clinically effective drug before “stepping up” to a more costly one.
Frequently Asked Questions About Part D
If you are 65 or older or already enrolled in Medicare, you are eligible for Medicare Part D.
When reviewing Part D plans, you might want to consider whether:
- Your preferred pharmacy is in the plan network
- Your medications are covered by the plan formulary (covered list) and if they offer generic options
- The plan offers generic options for cost savings
- The plan fits your budget when it comes to premiums, deductibles, copays, and out-of-pocket maximums
- You can save on mail-order medications with 30-day or 90-day supplies
If you have Original Medicare or a Medicare Supplement plan, you can sign up for a Medicare Part D plan during:
- Your Initial Enrollment Period, which starts three months before your 65th birthday month and ends three months after it
- The General Enrollment Period: January 1 to March 31
- The Annual Enrollment Period: October 15 to December 7
You can add, change, or drop your Medicare Part D plan during the Medicare Annual Enrollment Period. You could also qualify for a special enrollment period.
Learn More About Medicare Enrollment Periods
Most Medicare Part D plans have a coverage gap – the “donut hole” – that puts a temporary limit on how much the plan pays for prescription drugs. It starts once you and the plan have spent a certain amount on prescription drugs. When you’re in the coverage gap, you will pay a higher cost share on your prescriptions. Once your spending reaches the upper limit of the coverage gap, you shift back down to pay a lower cost share for your prescriptions. The coverage gap is scheduled to close in 2025.
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Read Our Medicare Articles
Get more details about Medicare Part D and important cost considerations. You can also take a deeper dive into other articles offering detailed information about Medicare plans, benefits, eligibility, enrollment, and more.
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