What is Medicare Part D?
Medicare Part D serves as a prescription drug coverage plan that helps beneficiaries obtain prescription drugs (including a lot of recommended shots and vaccines) at more affordable rates. Original Medicare, Part A, and Part B cover only hospital and medical insurance, leaving prescription drugs separate. To obtain medicare drug coverage, you must enroll in a Medicare-approved plan that has drug coverage. Each plan differs in costs and drugs covered.
Medigap plans do not include Stand-Alone Medicare Part D coverage. Seniors tend to purchase a drug plan besides their Medigap plan unless they have other creditable coverage.
Medicare Part D and Prescription Drug
Who is Eligible for Medicare Drug Coverage?
If you are eligible for Medicare, then you are also eligible for Medicare Part D coverage. Medicare Part D coverage is not automatically added to your plan. To add Part D prescription drug coverage, you must currently be enrolled in Medicare Part A, Part B, or both. Unlike Original Medicare, Part D is only offered through private insurance plans.
Consider enrolling in a Part D plan if you are not covered for prescription drug coverage, as waiting will come with premium penalties. An additional 1% of your average premium per month is added as a penalty. You will pay that penalty for as long as you are enrolled in Medicare Part D except if you meet all requirements for an exemption.
Here are some useful tips for choosing the best Medicare Drug Coverage for you:
- If you are taking a specific drug, make sure to check the formulary or list of prescription drugs covered by your chosen drug plan. If it doesn’t, try to look at other plans that might be a better fit.
- Consider drug plans with low to no deductible.
- If the majority of your prescriptions are generic, consider looking at drug plans with “tier” that charge you nothing or low copayments.
- Look for drug plans that provide coverage in the coverage gap that will benefit you to avoid paying for high-prescription drugs.
- See if the plan offers a mail order option, this will help to reduce your co-pay costs and will be easier for you to get your medicare prescription drug.
When choosing a plan, don’t just focus on the premium amount. You should also take a look at other factors such as the estimated out-of-pocket amount that you will have to pay yearly.
Enrolling in Medicare Part D
If you have Medicare Part A or Part B, you can enroll for Medicare Part D simultaneously. Like Medicare Part B, you do not need to enroll in Part D during your initial enrollment period at age 65, but the monthly premium may increase the longer you wait. However, if you are still working at the age of 65 and receiving employer creditable insurance drug coverage, you can delay the enrollment without penalty. Outside of your initial enrollment, Part D enrollment is mainly limited to an annual enrollment period.
How To Get a Medicare Prescription Drug Plan?
Great question. If you wish to shop plans in your area you can watch the video below. You may also reach out to us at 1-888-559-0103.
Prescription Drug Benefit
Part D covers both brand-name and generic drugs. The federal government requires guaranteed coverage for certain medications under Medicare Part D. However, which specific drugs will depend on the individual Part D plan you choose. You should make sure the plan you select covers the prescription drugs or medications you take if available through Part D. Some medicines are not available through Part D, and folks find other ways to buy them.
Each plan will list the prescription drugs they cover, which is referred to as the formulary. Drug plans may change as new drugs are released, or new therapies or medical information becomes available. If this happens, you will receive written notice at least 60 days before the change.
Your plan’s formulary may also place drugs in different “tiers” to lower costs. For example, the most generic drugs would go in Tier 1, also having the lowest copayment. At the same time, non-preferred brand-name drugs would be in a higher Tier 3 and also carry a higher copayment. This is something to keep in mind when choosing your plan.
It is important to note that your plan won’t cover any drugs excluded by Medicare or drugs not explicitly listed in its coverage. Also, some medications may already have coverage under Medicare Part A or B and are therefore not covered by Part D.
A licensed agent can help you determine if Medicare Part D first your current needs. Connect directly with one of our agents to learn more with no obligation.
For details on how drug plan coverage works with other insurance, click here.
Medicare Part D Costs
Part D plans generally charge a monthly premium. Some plans may also charge an annual deductible. You will be charged either a copayment or coinsurance for new prescriptions and refills with your Part D plan.
The out-of-pocket costs you pay will depend on which Part D plan you choose. Additionally, the area in which you live determines what is offered in your Part D drug plan. For this reason, you want to make sure you understand the coverage provided by the plans in your state. A licensed agent can walk you through the different plans and ensure the plan you choose covers your prescription drugs at the best available price.
Note: If there is an increase in your drug costs compared to the previous year, talk to your doctor. There may be cheaper alternative drugs available that you can use instead. This could save you money in your out-of-pocket costs annually.
We look forward to assisting you with your Medicare coverage and ensuring that our clients choose the right medicare drug plan. If any of this sounds confusing, you’re not alone. We have Medicare agents in your area standing by. Give us a call today! Connect directly with one of our independent agents to learn which Medicare Part D plan meets your prescription drug needs.
Got more questions? Visit our Medicare Part D FAQ page.
Prefer to chat by phone? Give us a call at 1-888-559-0103.