All Medicare found 27 Medicare Part D prescription drug plans available in Texas for 2023. See Plans
Texas Part D Plans By The Numbers
- Average premium: $47.96 per month.
- Lowest premium: $6.60 per month.
- Average deductible: $402 per year.
- Plans with no deductible: 4.
- Plans rated 4-stars or better: 0%.
- Basic benefit plans: 10.
- Enhanced benefit plans: 17.
- Full Low-Income Subsidy plans: 5.
- Plans with extra gap coverage: 5.
All Plans Have Four Cost Phases
A Medicare prescription drug plan is extra coverage you can get in Texas to help you pay for your prescriptions. Part D plans, or PDPs, don't cover all costs, but they do cover a lot. But, how these plans work can be confusing, so let's go over the four phases of cost-sharing.
Phase 1: The Annual Deductible
An insurance deductible is an amount you must pay before your policy pays its share. Most Medicare Part D plans have a deductible, but a few plans don't. When a plan has a zero-dollar deductible, you have first-dollar coverage. However, if you choose a plan with a $450 deductible, that's what you'll pay at the pharmacy before the plan kicks in and starts paying its share.
NOTE: Some Medicare Part D plans exclude Tier 1 drugs from the annual deductible. With these plans, you get first-dollar coverage on most of your generic drugs.
Phase 2: Initial Coverage Limit
The Initial Coverage Limit starts once the deductible is paid. It is the same for all plans. The amount this year is $4,660. In this phase, you and your plan split all costs up until your total retail spend on prescriptions exceeds $4,660. You pay the formulary amount. The plan will pay the rest. If your medication costs $50, and the formulary calls for a 10% copay, your share will be $5.
CRITICAL: When the total cost of your prescriptions exceeds $4,660, you go into the next please, the Coverage Gap (aka, "donut hole").
Phase 3: The Medicare Part D Coverage Gap
Your share on all brand-name drugs will be 25% in the Coverage Gap phase. The manufacturer is required to give a 70% discount, while your Medicare Part D plan will take the remaining 5%. This continues until you reach $7,400 in True Out Of Pocket Costs (TrOOP). Your TrOOP includes the 25% that you pay and the 70% discount received from the manufacturer.
TIP: Some plans offer additional gap coverage, so look for it on the plan information pages.
Generic drugs have a different situation. The 25% you pay yourself counts towards your TrOOP. However, your Part D pays the other 75%., which does not count towards tour TrOOP.
Phase 4: Part D Catastrophic Coverage
All Part D plans sold in Texas offer catastrophic coverage once you have paid $7,400 out-of-pocket for covered drugs. This amount includes the cost of covered drugs as well as some additional costs. In the catastrophic coverage phase, your copays or coinsurance will be significantly lower for the remainder of the year.
Costs That Help You Get Catastrophic Coverage
- Your plan's deductible;
- What you paid during the initial coverage limit period;
- Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
- The amount paid by others, including family members, most charities, and other persons on your behalf; and
- The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.
Most Texas Medicare Advantage Plans Include Part D Benefits
There are two ways can you get Part D prescription drug benefits. All Medicare prescription drug plans sold in Texas work with Original Medicare. But, there's a second way to get coverage. Perhaps you would like more benefits that Original Medicare provides. In this case, a Medicare Advantage health plan might be exactly what you're looking for. Most Medicare Advantage in Texas and Medicare SNP Plans in Texas include Part D coverage.
A Medicare Supplement + Medicare Part D = Full Coverage
Original Medicare offers 80/20 coverage on your major medical costs. With Original Medicare, you pay about 20 percent of all hospital and medical bills and Medicare pays 80 percent. Without additional coverage to help pay your 20 percent share, even a brief hospital stay can be a big expense. That's why we maintain a complete directory of Texas Medicare supplement insurance companies. The Medicare Wizard makes it super simple to get the best rates on the coverage you want. All Medicare supplement policies sold in Texas are compatible with Medicare Part D plans. You can mix and match.
Medicaid and Your Texas Medicare Part D Plan
If you are eligible for Medicare and Medicaid (aka "dual eligible", or "Medi-Medi") you may be automatically enrolled in a pre-selected Texas Medicare Prescription Drug plan and Social Security’s Extra Help program. You must meet strict eligibility requirements to receive Extra Help, which will pay most of your prescription costs. Contact your local Medicaid office for more information.
The 2023 Medicare Part D Plan information for Texas was last updated by the All Medicare team on