What Is Medicare Part D?

Medicare Part D, often referred to as the prescription drug benefit, provides prescription drug coverage for Medicare beneficiaries. This benefit is made available through private health insurance companies, either as an independent plan, called Part D for those who are beneficiaries of Original Medicare or packaged within your Medicare Advantage Plan benefits.

Enrolling in Part D as soon as you become eligible for Medicare is advisable unless you have you will have creditable coverage somewhere else like through an employer plan or the VA. Failing to enroll may result in coverage interruptions and potential penalties for late enrollment.

What Does Part D Cover?

Part D prescription drugs help cover the cost of medications that Medicare beneficiaries are prescribed to take by their doctor. This can include those in “protected classes” like cancer or HIV/AIDS treatments. Ensuring access to necessary medications is crucial for the health and well-being of individuals with Medicare.

A Part D drug plan can adjust its drug list throughout the year, following Medicare guidelines. These changes reflect advancements in therapies, new medications, and updated medical information. By staying responsive to evolving healthcare needs, the plan ensures a current and beneficial drug list for its members.

Your plan’s coinsurance may increase if the drug manufacturer raises the price of a specific brand or generic drug. Your copayment or coinsurance may also rise if your plan starts offering a generic version of a brand-name drug, but you prefer the brand-name drug. Note that your plan may cover a drug for one health condition but not another.

How Does Part D Work?

Part D plans typically have a monthly premium, annual deductible, and cost-sharing in the form of co-payments or coinsurance. The specifics of these costs vary between plans and depend on factors such as the type of prescriptions you take and which pharmacy you use.

To use your Part D coverage, you will need to present your Part D plan card at the pharmacy when filling a prescription. The pharmacy will then bill the plan for the cost of the medication. If you have a Medicare Advantage Plan with Part D coverage, you may need to use in-network pharmacies to receive coverage.

If your medication is not covered or requires prior authorization, your doctor can work with your Part D plan to request coverage. In some cases, exceptions may be made for certain medications that are not on the plan’s formulary.

What Does Part D Cost?

The cost of Part D can vary substantially based on where you live, the specific plan, the drugs you take, the pharmacy you use, and if you qualify for extra financial help.

On average, the monthly premium for Medicare Part D plans is around $33, but this figure can fluctuate depending on the factors mentioned earlier.

Bottom Line

Medicare Part D is an essential benefit for those who require prescription medications. It’s crucial to enroll in a plan as soon as you become eligible to avoid potential penalties and coverage gaps. Understanding what your plan covers and how it works can help you make the most of this valuable benefit.

Sources: Medicare.gov

FAQ

Can I change my Part D plan after enrollment?

Yes, you can change your Part D plan during the Annual Election Period (AEP) from October 15 to December 7 each year. You may also qualify for a Special Enrollment Period if you experience certain life events or have a five-star rated plan available in your area.

What if I have limited income and resources?

If you meet certain income and asset requirements, you may qualify for extra help from certain programs, which provide assistance with Part D premiums, deductibles, and cost-sharing. You can learn more about these programs by contacting your medicare.gov or your local SHIP agency.