What is Medicare Part D?
Medicare Part D is Medicare’s prescription drug benefit that provides outpatient drug coverage. Part D is provided through private insurance companies contracted with the federal government.
If you want Part D coverage, you have to either buy a standalone plan or get it through a Medicare Advantage plan.
What Drugs are Covered?
Prescription Drug Plans and Medicare Advantage Prescription Drug Plans cover all vaccine drugs when necessary to prevent illness. Other than that, you will have a formulary unique to your plan that details what drugs are covered. So, before you choose a plan, you need to talk to a licensed Medicare specialist like the ones at Tara Fenn @ Insured Oasis to make sure all the drugs you require are covered with your plan.
You are Notified of Any Changes
You can rest assured that all Medicare Prescription Drug Plans are required to publish any changes to its formulary on the plan’s website. The insurance company must also tell you when drugs are removed from the Part D formulary.
All plans are restricted from making changes to the drugs provided and making price changes between the beginning of the annual election period until 60 days after coverage begins. The only exception is if the FDA determines a drug is unsafe or the manufacturer ceases production of the drug.
Also, any changes must include the name of the drugs removed, if the drug changes tiers, the reason for the change, alternate drugs available, any cost sharing, and exceptions available.
Your Rights to a Prescription Drug Plan
Once you purchase a prescription drug plan, you have the right to:
• Receive a written explanation from your plan about your benefits
• Ask for exceptions if a drug you need is not covered by your plan
• Ask for exceptions to waive coverage rules
• Ask for lower copayments for higher-cost drugs if you or your prescriber believe you can’t take lower-cost drugs for your condition
Part D Coverage Levels
Every Part D plan has 4 levels of coverage. You move from one level to another based on your drug expenses for the year.
Deductible– You pay the full amount of your medications until you reach the plan’s yearly deductible. Depending on the plan, your deductible may be less and may not apply to generic medications. Some plans have a $0 deductible.
Initial Coverage– You pay a co-pay or co-insurance for your medication depending on which “tier” it is. For instance, Preferred Generics cost less than Brand Name, which cost less than Specialty Drugs.
Coverage Gap– This is often referred to as the "Donut Hole" phase. You pay a percentage of the cost of your medication. During this phase, you typically pay more for your prescription drugs until you reach the next threshold.
Catastrophic Coverage– During this phase, your costs decrease significantly. You'll only pay a small coinsurance or copayment for your covered drugs, and your Part D plan covers most of the remaining costs for the rest of the year. You'll remain in this coverage level until January 1st when you reset back into the deductible.
Please Don't Make this Mistake!
If you go without creditable prescription drug coverage, you'll have a lifetime penalty added on each month if you ever decide to enroll in Part D in the future. This is what's called a "Part D late enrollment penalty."
Medicare doesn't have to be so Hard
We understand learning about all of your Medicare options can be difficult and time consuming. We help clarify everything quickly so you can make the best decisions for you.
Medicare required disclaimer: We may not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.