Medicare Part D
If you have Medicare, you can get prescription drug coverage (Part D) through Medicare. In order to get Medicare Part D, you must join an approved insurance company. Each plan varies in cost and in the drugs which they cover. If you want Medicare Part D, you need to choose a plan that works with your health coverage.
Two ways to get Medicare prescription drug coverage are: stand-alone Medicare Prescription Drug Plans (these add drug coverage to Original Medicare), and Medicare Advantage Plans (all of your Part A and Part B coverage, including Part D are included in these plans).
Even if you take little to no prescription medications at this time, you should still consider joining a Medicare drug plan. If you choose not to join a Medicare drug plan when you are first eligible, and you do not have other creditable prescription drug coverage, you will likely pay a late enrollment penalty (this results in higher premiums) if you choose to join later.
You can join, switch, or drop a Medicare Part D Plan during the following times: when you first become eligible for Medicare or between October 15 and December 7 of every year (your coverage will begin on January 1 of the following year). In certain situations you may be able to join, switch, or drop Medicare Part D Plans during a special enrollment period (like if you lost creditable drug coverage, move out of the service area, or if you qualify for “extra help”).
You can choose a Medicare Part D plan by calling your local State Health Insurance Assistance Program (SHIP) and having them compare Part D Plans that are right for you. Once you choose a Medicare Drug Plan, you join by calling the plan or enrolling online. Depending on your situation, you can also switch to a new Medicare Part D plan by joining another plan during one of the times mentioned above. You do not need to cancel your old Medicare Part D plan or send them any information.
All Medicare Part D Plans must provide at least a standard level of coverage set by Medicare. That being said, exact coverage and costs differ from plan to plan. Your actual drug plan costs will vary depending on the drugs you take, the plan you choose, whether you go to a pharmacy in your plan’s network, and whether you qualify for “extra help” paying your Part D costs. The following are descriptions of the payments you make throughout the year in a Medicare Part D Plan:
Monthly premium: A monthly premium is the amount a drug plan charges per month; fees vary by plan. You pay this premium in addition to the Part B premium. If you belong to a Medicare Advantage Plan that includes prescription drug coverage, the monthly premium may include an amount for the prescription drug coverage.
Yearly deductible: A deductible is the amount you will pay out-of-pocket for your prescriptions before your Medicare Part D plan begins to pay. Some plans do not have a deductible.
Copayments or coinsurance: These are the amounts you pay for your prescriptions after you have met your deductible.
Coverage gap: Most Medicare Part D Plans have a coverage gap. The coverage gap occurs when you and your plan have spent a certain amount of money for covered drugs. During this time, you have to pay 50% of costs out-of-pocket for your brand-name drugs up to a limit. You will pay 86% towards generic drugs. The yearly deductible, the copayments, and what you pay in the coverage gap all count toward this out-of-pocket limit. Be sure to check with your plan to see if your drugs will be covered during the gap.
Catastrophic coverage: “Catastrophic coverage” begins once you reach your plan’s out-of-pocket limit during the coverage gap. Catastrophic coverage assures that once you have spent up to your plan’s out-of-pocket limit for covered drugs, you are only responsible for paying a small copayment for the rest of the year.
For a free, non-biased drug comparison, fill out this form and mail it to your local SHIP office.