Medicare Part D refers to Prescription Drug Plans and is an important part of your health coverage when on Medicare.
In this blog post, we will delve into the details of Medicare Part D, explaining its purpose, coverage, and eligibility requirements. Read on to gain a comprehensive understanding of what Medicare Part D entails and how it can benefit you.
What is Medicare Part D?
Medicare Part D is a component of the Medicare program that focuses on providing coverage for prescription drugs.
Contrary to what some believe, Part D is not offered directly by Medicare like Part A and B but through private insurance companies approved by Medicare. Medicare Part D plans help individuals with their medication costs by providing access to a list of covered drugs (formulary) at different cost-sharing levels.
You can get Part D coverage either by buying a standalone drug plan or enrolling in a Medicare Advantage (Part C) plan which has drug coverage built in.
Coverage and Benefits of Medicare Part D
- Prescription Drug Coverage:
Medicare Part D provides coverage for a wide range of prescription medications, including brand-name drugs and generic drugs. The specific drugs covered vary by plan, so it's essential to review the plan's formulary to understand which medications are included.
Regardless of plan, the federal government requires each plan to include at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need
- Cost-Sharing:
Medicare Part D plans typically involve cost-sharing, which includes premiums, deductibles, copayments, and coinsurance. The cost-sharing amounts can vary between plans and depend on the specific medications prescribed.
- Drug Formularies:
Each Medicare Part D plan has its own formulary, which is a list of covered medications. Formularies are organized into tiers, with different levels of cost-sharing for drugs in each tier. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. Understanding the formulary is crucial to determine coverage and associated costs.
- Coverage Gap (Donut Hole):
Medicare Part D includes a ‘coverage gap’, also known as the "donut hole." This refers to a temporary limit on what the plan will cover for prescription drugs. However, thanks to healthcare reforms, the coverage gap has gradually been reduced over time.
In general, if the total retail value of your drugs claimed under a drug plan reaches $4,660, you will enter the coverage gap and will have to pay 25% of the cost of drugs.
Medicare Part D Eligibility and Enrollment
Eligibility:
To be eligible for Medicare Part D, individuals must be eligible for Medicare Part A or enrolled in Part B. Additionally, they must live within the plan's service area.
Enrollment Periods:
Initial Enrollment Period (IEP): When you first become eligible for Medicare, you have an Initial Enrollment Period to sign up for Medicare Part D.
Annual Enrollment Period (AEP): Occurring from October 15 to December 7 each year, the AEP allows individuals to join, switch, or drop Medicare Part D plans.
Special Enrollment Periods (SEPs):
Certain circumstances, such as losing creditable prescription drug coverage, may qualify you for a Special Enrollment Period outside the regular enrollment periods.
Considerations and Plan Selection
Formulary Coverage: When choosing a Medicare Part D plan, review the plan's formulary to ensure it covers the prescription medications you need. Consider the drug tiers and associated cost-sharing levels.
Preferred Pharmacies: Medicare Part D plans often have a network of preferred pharmacies. Verify if your preferred pharmacy is included in the plan's network to access prescription medications conveniently.
Cost Comparison: Compare the premiums, deductibles, copayments, and coinsurance of different Medicare Part D plans to find one that best suits your medication needs and budget.
Compare Medicare Part D Plans
Medicare Part D plan options vary from company to company, and each insurance provider can choose which specific drugs are included in its formularies for each category. When comparing plans, you’ll want to consider:
- Premium price and how it fits into your monthly budget
- Copays for frequently needed medications
- The medications that you’re currently taking and how they fit in each plan’s formulary
- Your location and the insurance providers authorized to provide plans in your area
If you aren’t sure where to begin your search for your best option for Medicare Part D 2021 coverage, consider a few of Benzinga’s top providers below.
Conclusion
Even if you aren’t currently taking any prescription drugs, you should still begin comparing options for Medicare Part D 2021 coverage. You never know when you might need to begin a medication — and you may not be able to enroll in coverage if you miss Medicare’s Open Enrollment period. Remember, too, that you can purchase Medicare coverage in some cases and retain your regular insurance policy (with penalties.) This may be advantageous to you depending on your medical situation or the medications you’re currently taking.
Be sure to compare your options and get a quote from a few of Benzinga’s recommended providers so you know all your options when you sign up for Medicare coverage.
Frequently Asked Questions
What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
What is the deductible for Medicare Part D?
Deductibles vary between Medicare drug plans. However, no plan provider can charge a deductible higher than $445.
What is the cost of Medicare Part D?
Medicare Part D premiums vary by insurance company, and each company sets its own monthly premium for each plan it offers. Comparing multiple Medicare Part D plan choices can help ensure you get affordable coverage.
About RIchard Chan
Medicare, health insurance, life insurance, consumer lending, capital markets, macroeconomics, mergers and acquisitions.