Medicare beneficiaries can obtain prescription drug coverage by enrolling in a Medicare stand alone prescription drug plan (Part D) or by enrolling in a Medicare Advantage plan (Part C) with a drug component.
In 2016, 1,075,004 enrolled in a Stand Alone Pennsylvania Prescription Drug Plan and 884,735 enrolled in an Pennsylvania Medicare Advantage Plan with prescription drug coverage.
Medicare drug plans cover a portion of all covered prescription drug costs after the enrollee has paid their annual drug deductible. However an enrollee’s actual drug costs will depend on their drug plan’s cost-sharing requirements for each drug tier, whether they use a preferred pharmacy in the plan’s network, whether their drugs are listed in the plan’s formulary (and if so, the tier in which the drugs are listed), and whether the enrollee is eligible for income-based subsidies.
Using CMS data HealthPocket found that:
- The average monthly premium for a 2017 Medicare prescription drug plan in Pennsylvania is $59.51, 11.82% higher than the national average of $53.22. The lowest available Medicare Part D monthly premium in the state of Pennsylvania in 2017 is $14.60.
- The maximum possible annual drug deductible in any 2017 Medicare drug plan is $400, but in Pennsylvania the average annual drug deductible for Medicare Part D plans is $206.36. 45.45% of Medicare Part D insurance plans in Pennsylvania have a $0 annual drug deductible.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part D plans each year based on customer service, member complaints, member satisfaction, patient safety, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average CMS star rating assigned to Medicare Part D insurance plans in Pennsylvania was 3.4 stars in 2017.
- Among Pennsylvania's 2017 Medicare prescription drug plans with CMS star ratings:
- 36.36% earned a score of 4 or 4.5 stars
- 40.91% earned a score of 3 or 3.5 stars
- 18.18% earned a score of 2.5 stars
- 4.55% of plans are “Not enough data available”.
Medicare Enrollment Dashboard: