What is Medicare Part D?

Medicare Part D is a prescription drug plan (PDP) designed to help Medicare beneficiaries access affordable prescription drugs. It became available in 2006 and is a part of Medicare’s expansion of the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This article will help you understand what it covers and how you can enroll.

Where do you get Medicare Part D Coverage?

Since Original Medicare does not provide stand-alone Medicare prescription drug coverage, plans are sold by private insurance companies. The private insurance companies are not required to have plans available nationwide, so this means that the stand-alone plans in your area may be different from other parts of the country.

What does a Medicare Part D prescription drug plan cover?

Part D plans may cover a variety of prescription drugs, both brand name and generic drugs. It is important to note that each plan has its own formulary, a list of covered medications, so not every drug is covered under every plan and not every plan is the same. The coverage is based on the plan you choose and the specific medication that you need.

What drugs are covered under Medicare Part D?

Prescription Drug Plans cover a wide range of drugs. The covered drugs depend on the specific plan that you choose. However, all plans must cover a minimum set of drugs used to treat common medical conditions. The list of covered drugs is called the plan’s formulary, and it is important to check this before selecting a plan.

What are the Medicare Part D costs?

The cost of Part D can vary significantly, depending on the plan you choose and the specific drugs that you need. All plans have premiums, deductibles, copays and coinsurance. The cost of the plan also includes the cost of the drugs that you need. Since Original Medicare doesn’t cover Medicare Part D drugs, it is important to compare plans to find one that fits your budget and covers medications in your drug lists.

What is covered on a Medicare Part D Plan?

Medicare requires all plans to include a wide range of drugs commonly used by their beneficiaries, such as those used for cancer or HIV/AIDS treatment. Each plan has its own list of medications covered, known as a formulary. These formularies typically categorize drugs into tiers, which determine their cost. Generally, drugs in lower tiers are less expensive compared to those in higher tiers.

What is a formulary?

The formulary is a list of drugs, both generic and brand-name, that are covered under the specific Part D plan that you choose. Each plan has its own formulary tiers, so it is important to check the formulary before selecting a plan.

What are the different tiers in Part D?

The different drug tiers refer to the different levels of coverage for different types of drugs. Generally, there are six different tiers of coverage, with tier 1 being the lowest and least expensive medications and tier 6 being the highest and most expensive medications.

What is the annual deductible for Part D drug costs?

The deductible for Part D drug costs varies from plan to plan and from year to year. It is the amount that you must pay out of pocket before the plan begins to cover the cost of your medications. Each year Medicare determines the maximum deductible.

How do I enroll in Medicare Part D plan?

Once you have evaluated the many plan options, enrolling in a Medicare Part D plan is a straightforward process that can be done online, by phone, or by mail. You can enroll during your initial enrollment period, during the annual enrollment period, or during a special enrollment period if you qualify for a special enrollment period.

What is the premium for Part D coverage?

The monthly premium for Part D coverage varies from plan to plan. It is the amount that you must pay each month for the coverage.

What pharmacies accept Medicare Part D?

Most pharmacies accept Medicare Part D. It is important to check with your preferred pharmacy to ensure that they accept the plan that you choose.

What is the initial coverage limit under Medicare Part D plan?

The initial coverage limit under Medicare Part D plan is the amount that the plan will pay for prescriptions before you enter the coverage gap.

What is the coverage gap in Medicare Part D?

The coverage gap in Medicare Part D is the period when you must pay a higher percentage of your prescription drug costs. It begins after you reach the initial coverage limit and ends when you reach the out-of-pocket limit. The gap limits are set by Medicare each year.

What is the out-of-pocket limit for Medicare Part D?

The out-of-pocket costs limit for Medicare Part D is the maximum amount that you must pay in copays for your prescription drugs before the catastrophic coverage begins. Medicare sets this limit each year.

What is the catastrophic coverage under Medicare Part D?

The catastrophic coverage under Medicare Part D is the period when the plan pays most of the cost of your prescription drugs. It begins after you reach the out-of-pocket limit.

What are the different options to get drug coverage?

There are different ways to get the drugs you need covered are stand-alone prescription drug plans or Medicare Advantage (Part C) plans that include coverage.

What is the difference between Medicare Part D and Medicare Advantage?

Medicare Part D plans provide coverage only for prescription drugs, while Medicare Advantage Plans (Part C) provide additional coverage for hospitalization, doctor visits, and other medical services.

Are Part D Prescription Drugs Covered Under Original Medicare Part A and Part B?

Unfortunately Original Medicare does not normally provide covered prescription drugs. Since Medicare Part D covers prescription drugs and pays for your covered medications, people with Medicare, taking prescription drugs should chose a plan when they sign up for Medicare.

How do I find Medicare Part D plans in my area?

You can find plans available in your area by using the Plan Finder tool on the Medicare website or by calling a local Licensed Independent Medicare Insurance Agent, like the ones at American Entitlements at 469-814-0289. It is important to compare plans to find one that fits your budget, work with your pharmacy, and provide the coverage you need. Make sure to check the plan’s formulary, different tiers, and deductible before enrolling.

We’re Here to Help

Getting prescription drug coverage that you can rely to help cover your medications does not have to be confusing or frustrating. The Medicare Insurance Agents at American Entitlements are well trained and ready to answer your questions about Medicare. Give us a call at 469-814-0289 to learn more about Medicare and ways to help lower your costs.