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What is a Medicare Part D Prescription Drug Plan?
Medications are a big piece of your Medicare Insurance plan. It’s important to know that Original Medicare (Parts A and B) do not cover prescription drug costs. But you can get these types of costs covered through Medicare Part D, which is a federally administered program through private insurance companies. Medicare beneficiaries can:
- Enroll in a standalone Part D Drug plan that goes alongside their Original Medicare
- Choose a Part D Drug plan that is built into a Part C Medicare Advantage plan
- Select a standalone Part D Drug plan to accompany a Medicare Supplement Plan
*Medicare Part D enrollment has doubled since 2006, now totaling 45 million people in 2019. This represents 70% of all Medicare beneficiaries.
How does Medicare Part D work?
Medicare Part D is insurance for your prescription drug needs. You pay a monthly premium to an insurance carrier for your Part D plan and use the insurance carrier’s network of pharmacies to buy your medications. Instead of paying the full price for the prescription medication, you will pay a copay or a percentage of the drug cost, while the insurance company pays the rest.
What does a Medicare Part D Prescription Drug Plan cost?
Most Medicare Prescription Drug plans charge a monthly premium that varies by plan and where you live. In 2019, the annual deductible for Medicare Part D was $415. Depending upon the plan, you may be charged the full Part D deductible, a partial deductible or have the entire deductible waived. When you need a prescription filled, you will pay the network discounted price for your medications until you have satisfied the deductible. Once you’ve reached the deductible, you will pay a copay for your medications based on the drug formulary. The insurance company tracks the amount spent by both you and the insurance company until you have together spent a total of $3,820 in 2019. Once you hit this limit, you will pay only 25% of your brand name medications and 37% of generics. You will continue these amounts until your total out-of-pocket costs have reached $5,100 in 2019.
When can I enroll in a Medicare Part D Prescription Drug Plan?
Medicare prescription drug coverage is an optional benefit available to anyone who has Medicare. If you don’t sign up for Part D when you’re first eligible, you may have to pay a Part D late enrollment penalty. You may enroll in a Medicare Part D Prescription Drug plan:
- during your Initial Enrollment Period,
- if you qualify for a Special Enrollment Period,
- during the Medicare Open Enrollment, which runs from January 1 through March 31,
- during the Medicare Advantage and Prescription Drug Annual Enrollment Period (AEP), held each year from October 15 through December 7
Part D Drug plans may have changes from year to year. Your plan’s benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1st of each year. Therefore, it’s a good idea to talk to a licensed sales rep during the Medicare AEP timeframe each fall to understand any changes to your current plan and identify if you should switch to a different plan for the coming year.
Our licensed sales agents are equipped to help you
determine what Medicare plans are available in your area and want to help you receive all the available benefits you deserve. The Medicare Helpline is ready to talk with you about Medicare Part D Plans – just call or complete the online form today!
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Understand Your Medicare Options
The Medicare Helpline is here to help! Our licensed sales agents are here for you and they know Medicare inside and out. We will provide side-by-side comparisons to help make it easy for you to decide which plan is right for you. Get started by entering your zip code below:
No obligation to enroll.