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What Do You Need To Know
Understanding Medicare Part D: Your Guide
Medicare comes in many different shapes and sizes, intended to support your medical, hospital, and prescription needs. Medicare Part D is the solution you’ll pay for if you want to reduce the costs of a covered drug for your Medicare health plan.
Medicare offers prescription coverage in two ways. First, if you have original Medicare with part A and B coverage, then you will need part D coverage for your drug plan. You can enroll for a Part D plan using stand-alone insurance.
On the other hand, if you have the Medicare Advantage plan, otherwise known as part C, then you can get the prescription drug benefit as part of the advantage coverage. The Medicare advantage prescription drug coverage comes with several different factors to choose from.
Medicare Part D drug coverage is available through a host of private insurance companies approved by the Medicare Health plan. Unfortunately, this means that cost and availability will often differ between locations, plans, and insurance companies.
Who is Eligible for Medicare Part D Prescription Drug Coverage?
So, how do you get drug coverage from Medicare Part D?
You’re eligible for this kind of coverage if you are enrolled with Medicare Part A and/or B. You also need to live in the service area of the Part D coverage you want to access. You’ll be eligible for Medicare Part D if you enroll in a prescription drug stand-alone plan or Medicare Advantage plan with copay or coinsurance.
Your enrollment options include:
- Initial enrollment period for Part D: This is the period that you’re first eligible for Medicare prescription drug coverage. The initial enrollment period often overlaps with the time when you can first get Medicare. Initial enrollment begins three months before your 65th birthday and lasts until three months after your birthday.
- Annual election period: Another opportunity to make changes to your Medicare Part D coverage is during the annual election period, between October 15th and December 7th. You can also sign up for a Part D prescription drug costs plan for the first time if you don’t have it.
- Medicare open enrollment: If you automatically enrolled in Medicare Part C, or Medicare advantage, and decide to switch to Medicare Part D with original Medicare, you can. The period for this enrollment is between January 1st and March 31st.
- Special election period: Outside of the enrollment options above, you can enroll in Medicare Part D insurance or make changes to your prescription drug coverage if you’re eligible for special election. You may be eligible for special enrollment if you move, lose your Medicare eligibility, or move into a care home.
Late Penalties for Part D Enrollment
If you’re not taking a prescription drug regularly now, it’s still generally a good idea to apply for Medicare Part D insurance as soon as possible. If you don’t take the time to compare Medicare Part D plans ahead of schedule and roll during open periods, it can be difficult to get enrollment later. Penalties for late enrollees include an additional cost that’s added to your coinsurance or copay plan.
To avoid a coverage gap, it’s worth signing up as soon as possible. This will help to keep your deductible and rug costs as low as possible. Also, if you have health coverage through your employer, you will be notified every year and told whether this coverage is creditable.
Remember: like a Medicare Advantage plan, Medicare Part D enrollment is optional coverage. However, if you don’t use a Medicare Part D plan finder and sign up when you have a chance, you may have a significant coverage gap and more fees to worry about later.
How Does a Medicare Part D Prescription Drug Plan Work?
The kind of drug coverage you get from your Medicare prescription drug plan will depend heavily on your chosen insurance company. You will need to shop for Part D coverage alongside original Medicare. Each program will come with formulas and a list of covered medications.
All coverage plans for drugs must include certain categories of medicine for the enrollee. However, the prescription drugs covered in the formulary may change between plans. That’s why it’s very important to check the prescription and generic drug options you can get with each Medicare Part D plan. You should also keep in mind that drug prices and the formulary may change at any time.
All plans for Part D Medicare coverage must include at least two prescription drugs per category. Usually, medicines include antidepressants, anti-psychotics, immunosuppressants, antineoplastic, and anticonvulsant medications.
Remember that if you fill prescription medications supported by your creditable coverage, you may be responsible for your medication’s retail cost. If your Medicare drug plans don’t cover a specific prescription drug within each tier list that your doctor thinks you need, you can ask for an exception. You can submit a request for the total drug costs in writing or over the phone. You will receive a decision from your Medicare drug plan within 72 hours.
What’s the Medicare Prescription Drug Premium?
When you’re exploring options for your insurance enrollment, it’s worth checking prices. Prescription drug insurance can differ from one company to the next. That’s because Medicare plans can set their own premiums and coinsurance payments. It’s also worth remembering that you need to add your existing Medicare plan to the cost of Medicare Part D.
You also need to pay for your original Medicare or Medicare Advantage plan along with your drug plan. Check the Medicare Gov website if you want additional insights into the factors that can affect your deductible and drug costs. Not that you may need to pay an extra cost on your drug plan if your income falls above a specific threshold. When using your Medicare Part D plan finder, check for the Income-related monthly adjustment amount.
Social security will tell you if you need to pay extra for your drug coverage. You can contact Social Security about coverage requirements online or over the phone. Alongside your insurance premium for prescription drug coverage, other costs might include:
- A deductible: The cost of Medicare Part D depends on whether you need to pay money out of pocket to cover costs. The government has a maximum deductible in place for Medicare plans that cover drugs.
- Copayments or coinsurance: You are also responsible for paying coinsurance or copay fees to get your medications after paying your deductible. A Copay cost is a fixed fee, whereas your coinsurance is a percentage of the fee.
- Donut hole or coverage gap: After spending a specific amount on your plan, you may need to pay an extra cost for a prescription coverage gap. This means that your out-of-pocket expenses temporarily increase. In the past, a Medicare beneficiary would have paid the entire prescription price after entering the coverage gap. However, recent legislation allows for discounts on these payments.
Getting Medicare Drug Coverage
Medicare Part D prescription drug insurance is an important consideration when looking for the right health insurance. Make sure that you compare Medicare Part D plans carefully. You can find some of the best-rated Medicare part D plans online and look into things like the catastrophic coverage you get and whether coinsurance or copay is necessary.
Consult a Medicare Agent
Questions about Medicare eligibility and enrollment? Or, if you are ready to enroll, consult an medicare agent today. Get Medicare plan options and information to find the right coverage to meet your needs.