- WPS offers Medicare Part D plans to residents of Wisconsin.
- WPS has a network that includes pharmacies in all 50 states.
- There are two different Part D plans available through WPS.
- The WPS MedicareRx Plan 2 has no deductible.
Wisconsin Physicians Service (WPS) is based in Madison, Wisconsin, and has been serving members throughout the state since 1946. Today the company offers various types of insurance coverage, including Medicare Part D plans.
WPS has two Medicare Part D plans available. Both plans allow members to access a broad network of pharmacies, as well as low copayments on generic prescriptions.
WPS offers Part D plans to residents of Wisconsin. You can get a WPS Part D plan in all counties statewide.
Though you’ll need to live in Wisconsin to join a WPS plan, you can use your plan throughout the country. The WPS pharmacy network extends beyond Wisconsin to offer pharmacy coverage in all 50 states.
So, a WPS plan may be a good option if you travel frequently or live in another state for a few months of the year.
WPS offers two different Part D plans:
- WPS MedicareRx Plan 1. Plan 1 is a basic Part D plan designed for members who don’t expect to use many medications. It also offers low premiums.
- WPS MedicareRx Plan 2. Plan 2 is designed for members who may have a lot of prescription drug needs. This plan provides some extra benefits to help bring down your out-of-pocket costs.
Both plans offer similar coverage. The primary difference is that Plan 1 has a deductible, whereas Plan 2 doesn’t. Plus, Plan 2 offers more coverage during a Part D coverage gap known as the “donut hole.”
For example, if you have the WPS MedicareRx Plan 1, you’ll pay a 25 percent coinsurance cost for generics during the donut hole. However, the WPS MedicareRx Plan 2 offers generics at no cost during the donut hole.
Both of the WPS Part D plans offer prescription coverage and access to the nationwide WPS network. Other coverage you’ll find with both plans includes:
- brand name drug coverage
- generic drug coverage
- discounted prices on 90-day mail-order supplies
- access to the Medication Therapy Management (MTM) program, which helps members manage multiple prescriptions and answers any prescription drug questions
Many Part D plans have different prices in each area or city they cover. This isn’t the case with WPS plans.
The two WPS plans have the same standardized costs throughout Wisconsin.
In the table below, you can get a closer look at some of the costs associated with each plan in 2020.
| WPS MedicareRx Plan 1 | WPS MedicareRx Plan 2 | |
|---|---|---|
| Monthly premium | $74.30 | $124 |
| Annual deductible | $435 | $0 |
| 30-day supply tier 1 (preferred generic) | $2 | $0 |
| 30-day supply tier 2 (generic) | $15 | $11 |
| 30-day supply tier 3 (preferred brand) | $42 | $42 |
| 30-day supply tier 4 (nonpreferred) | 45% coinsurance | 45% coinsurance |
| 30-day supply tier 5 (specialty) | 25% coinsurance | 33% coinsurance |
| Donut hole tier 1 | 25% coinsurance | $0 |
| Donut hole tier 2 | 25% coinsurance | $11 |
| Donut hole tiers 3–5 | 25% coinsurance | 25% coinsurance for tiers 3 and 4, 33% coinsurance for tier 5 |
As you can see, you’ll pay more each month for Plan 2, but your overall out-of-pocket costs will be less than with Plan 1.
Choosing the right plan for you will depend on your budget, the number of prescriptions you take, and what tier your prescription medications are in.
Note that your cost for any Part D plan is in addition to the cost of your other Medicare coverage.
Medicare Part D is coverage for prescription drugs.
Because neither part of original Medicare (parts A and B) includes coverage for prescription drugs you take at home, private insurance companies like WPS contract with Medicare to offer Part D plans.
These plans must follow regulations set by Medicare. For example, Medicare won’t allow Part D plans to cover certain medication types.
Medicare also regulates the out-of-pocket maximum that Part D plans can have. In 2020, plans need to have an out-of-pocket maximum of $6,350 or less.
What is a Part D formulary?
All Part D plans have a list of medications they’ll cover. This list is called a formulary.
A formulary lists generic, brand name, and specialty medications your plan will cover. It also lists your cost for those prescriptions.
Your plan won’t cover your prescription if it’s not on their formulary.
Before you enroll in a plan, you can check its formulary to make sure you’re covered for any prescription drugs you regularly take.
A great way to do this is to use Medicare’s plan finder tool. With this tool, you can enter all the prescriptions you take, along with your ZIP code. You’ll get matched with plans in your area that include your medications in their formulary.
What is the Medicare Part D late enrollment fee?
Medicare requires you to have some form of prescription drug coverage. You’re not required to have Part D coverage if you have prescription coverage from another source, such as your spouse’s employer health benefits.
However, you’ll need to show proof of this coverage if you sign up for Part D later. This will help you avoid paying a late enrollment fee. The late enrollment fee increases for every month you didn’t have Part D or other prescription coverage after your initial enrollment period.
Can I get prescription coverage with a Medicare Part C plan?
Medicare Part C might be a good option if none of the stand-alone Part D plans in your area meets your needs. Also known as Medicare Advantage plans, Part C plans combine both parts of original Medicare into one plan.
Many plans also include prescription drug coverage. This allows you to have all your healthcare coverage under one plan. Part C plans also often include extra coverage for things original Medicare doesn’t cover, like dental visits or vision care.
A Medicare Advantage plan with prescription drug coverage will satisfy Medicare’s coverage requirement. This means you won’t be charged any late enrollment fees if you decide to switch to a stand-alone Part D plan later.
WPS offers Medicare Part D plans throughout the state of Wisconsin. The company offers two plan options to meet members’ prescription drug coverage needs.
WPS offers access to a nationwide network of pharmacies, meaning that members can get prescriptions filled while they’re away from home. Coverage also includes access to the MTM program, which can help members manage and understand their prescriptions.
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