Medicare Part D (Drug Coverage)

What is Medicare Part D and who is eligible for the coverage?

Medicare Part D is prescription drug coverage. Anyone on Medicare (Part A or Part B) is entitled to drug coverage which is known as Part D. They are entitled to Part D coverage regardless of their income. No physical exams are required to receive Part D. Pre-existing health conditions or number of prescription drugs taken by an otherwise eligible individual will not disqualify them for coverage.

What is available in Part D coverage?

Most people choose to buy a stand-alone Part D plan to work alongside their Original Medicare coverage. Another option allows all Medicare coverage to be obtained through a Medicare Advantage Prescription Drug plan which consists of private insurance company coverage equivalent to Medicare A, B, and D. A professional insurance agent at InsuranceDirect123 can explain all of the options further.

How do I choose the best Medicare Part D plan for me?

Contact a professional agent InsuranceDirect123 to assist you in purchasing a Part D plan. This will ensure you choose a plan that covers your medications. Every Part D plan has a formulary that lists the drugs it covers. Many plans make their formularies available online.

What will I have to pay for Medicare Part D coverage?

Most beneficiaries have to pay a premium for Medicare Part D, along with costs such as deductibles (no more than $360 in 2016; $400 in 2017-paid by you the customer before the insurance policy kicks in), co-payments and coinsurance. These premiums and additional costs will vary among plans. Although Medicare Part D insurance is optional, if you do not enroll when you are first eligible for Medicare, you could face a late enrollment penalty if you decide you want this coverage at a later time. The late enrollment penalty is at least an extra 1 percent of the national average premium added to your regular assigned premium for every month that you delay and are without creditable drug coverage. You will pay the penalty, which generally increases each year along with an increase in the average premium, for as long as you have Medicare drug coverage. In other words, if you delay for 20 months, your Part D premiums will always be at least 20 percent more than other people pay or 20 percent more than what you would have paid if you had signed when first eligible. If you receive extra help or assistance (a subsidy based on your income) to pay for your drugs, you won’t face a late penalty.

Premiums, deductibles, and co-pays are not the same for every Medicare D policy.

There is no set monthly premium for Part D prescription drug coverage. Each private insurance company that offers a Medicare Part D drug plan sets its own premium for each calendar year. Some Medicare Advantage plans do not charge an extra premium for drug coverage. Your premium will depend on which insurance company you choose. Other out of pocket expenses will depend on what deductible and co-pays you must pay to the insurance company over the course of the contract year.

Medicare Part D insurance is a government sponsored program that assists Medicare eligible customers with prescription drug costs. This is a very complex program. Contact InsuranceDirect123 and ask a professional insurance agent to assist you with deciphering which Medicare D plan is best for you. Specific aspects of Medicare Part D such as costs during the deductible period, costs during the initial coverage period, how expenses change when entering and leaving the gap period or the doughnut hole, and how expenses change when entering the catastrophic period, prior authorizations, step therapy, quantity limits, exceptions, coverage determinations, preferred pharmacy networks, and much more can all be explained to you by the professional insurance agents at InsuranceDirect123.