Medicare Part D
Medicare Part D is a program that helps you pay for medication also known as prescription drug coverage. If you have Original Medicare or a Medicare Supplement Policy, you will need to enroll in a stand-alone prescription drug plan (or Part D) to help you pay for prescriptions (and avoid a penalty). Since enrollment is optional, you may choose not to enroll but will incur a penalty. So you might as well enroll. If you have a Medicare Advantage plan (Part C), your prescription drug coverage is included in that plan and you do not need to enroll in Part D. Let us walk you through this in a simpler way.
What You Need To Know About Medicare Part D
Premiums
Part D or Prescription Drug Plans have monthly premiums. You are responsible for paying this monthly.
Deductible
Part D or Prescription Drug Plans have deductibles. Each plan will vary on the deductible amount, ranging from $0 - $505 annually. This is the amount of money you are responsible to pay for your medications.
Co-Pays and Co-Insurance
Part D or Prescription Drug Plans have an initial coverage stage where you will have co-pays and co-insurance costs for your medications. Each plan has its own formulary and will classify its medications in different tiers. You will have a co-pay and co-insurance depending on how your plan determines each medication.
The Donut Hole
Part D or Prescription Drug Plans also have a coverage gap where you are responsible to pay for 25% of the cost of medications. For 2021, these amounts may be up to $4,660.
The $4,660 amount may be accumulated by your deductible, your co-pays and co-insurance, and any monies paid on your behalf towards medication by any person.
The Catastrophic Phase
Once you have paid out of your pocket $7,400 in medications, you enter the catastrophic phase. At this point, your costs are reduced to small co-pays or of the medication cost (whichever is higher).
A few other things to keep in mind...
- If you are still working, you may delay your Part D or Prescription Drug coverage enrollments as long as your employer or VA coverage is as good or better than Part D coverage. Otherwise, you will incur a 1% lifetime penalty.
- Speaking of penalties, this is a 1% of the base Part D premium for every month you don't have part D coverage.
- Every plan has its own formulary and will categorize medications into tiers. These will vary from plan to plan and may also change from year to year. This is why it is important to shop around each year and review your annual notice of changes which you will receive each year around September.
- Making changes. During the Annual Enrollment Period, you may make changes to your prescription drug coverage. This time period starts October 15th and lasts until December 7th. The plan will be effective on January 1st of the following year.
- Networks. Every plan has its own pharmacy network. It is important that you choose a plan that has a pharmacy nearby as well.
We know this is a lot of information, and thankfully we have trained professionals ready to help you.
Medicare Open Enrollment
I expressly consent to receive emails and phone calls via automatic telephone dialing system or by artificial/pre-recorded message, or by text message from licensed sales agents of MedicareOE, affiliates, partner companies and their partners at the telephone number above, including my wireless number if provided, message and data rates may apply. I understand that my consent to receive communications in this way is not required as a condition of purchasing any good or services. If you are Medicare-eligible, a licensed sales agent will contact you about Medicare-eligible, a licensed sales agent will contact you about Medicare plans by phone or email. Submitting this form does NOT affect your current Medicare Part A and Part B enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, Medicare Supplement plan or other Medicare plan. I acknowledge that I have read and understand the Terms and Conditions and Privacy Policy of this site and agree to be bound by it.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800 MEDICARE to get information on all of your options.
Not affiliated with the U. S. government or federal Medicare program.
Last updated: 01.05.2023 at 12:01 AM MULTIPLAN_SHDLEAWE002_M