Part D Prescription Drug Coverage

Does Medicare Have Coverage for Prescription Drugs?

Yes, Prescription drugs are covered under Part D of Medicare. People who have Medicare Part A or Part B are eligible for Medicare prescription drug coverage. They can enroll in any of the Part D plans that serve the area where they live.

The annual enrollment period for Part D is from November 15 to December 31. During that time period anyone with Medicare can enroll in a plan or change from one plan to another. There are some important things to keep in mind when it comes to prescription drug coverage:

It is very complex, can be confusing and is changing on a regular basis. You will have to make decisions to get the plan that is right for you and covers the drugs you need.
You can get help making decisions through local resources and/or your Medicare Advantage Plan (HMO, PPO).
You do not have to take Part D coverage. That decision will not affect the other coverage you have. A good thing to remember is you will have to pay a higher premium if you choose to enroll later, unless you can show Medicare you had drug coverage at least as good as theirs during the time you were not enrolled in Part D. This is known as creditable coverage.
When choosing a Medicare Part D plan, ask good questions and do your homework. You can also visit our section on Part D Information and Enrollment Center

Things you should ask:

Can I buy Part D drug coverage without having my Medicare replaced by an HMO product or Medicare Advantage Plan?
If I buy into the Medicare Advantage Plan that includes Part D coverage, will I be restricted on who I can go to for service?

How Can I Delay Reaching the Coverage Gap?

There are a number of things you can do to help reduce your drug costs, they include:

Switching to lower cost drugs: Talk to your doctor about using generic and/or over-the-counter (OTC) drugs. Many work as well as the higher cost prescriptions. It can help you save hundreds of dollars a year and can be just enough to keep you out of the coverage gap.
Take advantage of mail-order programs: They can save you many dollars a year on medication used long term (90 days or longer).
Always use your Medicare drug plan card. When you use your card you get discounted rates on the drugs you buy and any money spent on drugs is automatically counted automatically counted towards your deductibles.
Look for programs that offer assistance: Programs, such as the National Patient Advocate Foundation or the National Organization for Rare Disorders, may have programs that can help with your drug costs. Comprehensive information on federal, state and private assistance programs in your area is available at www.benefitscheckup.org.

Is There Help for People Who Have a Low Income?

If you have a low income you may have been automatically enrolled in a program (this may vary state to state). If you have not been automatically enrolled in the program you may still qualify for it. If you qualify, you will get help paying for your Medicare drug plan's monthly premium, deductible, and copayments. The amount of extra help you get is based on your income and resources.

You will automatically qualify for help if you meet one of the following criteria:

You get full coverage from a state Medicaid program
You get help from Medicaid paying your Medicare Part B premiums (a Medicare savings program).
You get Supplemental Security Income (SSI) benefits.

If you don't join a Medicare drug plan yourself, Medicare will enroll you in a plan so that you get help paying for your prescription drugs. However, if you have certain retiree drug coverage from a former employer or union, then Medicare will not automatically enroll you in a plan. If Medicare enrolls you, they will send you a letter letting you know when your coverage begins.

What Does Part D Cost?

Exact costs are different for each plan, depending on your coverage. Your actual costs for Medicare prescription drug coverage will depend on which drugs you use, which Medicare drug plan you join, and whether you go to a pharmacy in your plan's network.

In addition to your monthly premium your costs for Part D coverage are:

An initial $310 deductible.
After meeting the deductible the beneficiaries pay 25 percent of the cost of covered prescription drugs, up to $2,830.
Once the prescription drug costs are reached, you are subject to another deductible, known as the Coverage Gap, in which you must pay the full costs of drugs until a total out-of-pocket expense of $4,550 is reached (this includes the costs of the deductible and coinsurance).
Once you have reached the out-of-pocket costs, you qualify for "Catastrophic Coverage" and will pay $2.50 for a generic drug and $6.30 for other drugs, or a flat 5 percent co-insurance, whichever is greater.
An important thing to keep in mind is the $4,550 out-of-pocket threshold is an annual deduction that you will have to pay each year. You should expect those costs to increase each year.

What Kinds of Things Should I Consider When Choosing a Plan?

When reviewing prescription drug information, consider how much the plan will cost. There are a number of factors to look at when it comes to costs:

Premium: This is the monthly cost you will pay once you have signed up with the plan. Premiums vary by plan.
Deductible: This is the amount you pay for your prescriptions before your plan starts to share in the costs. Deductibles vary by plans. Some plans do not have deductibles; however, plans cannot charge more than $310 dollar for the yearly deductible.
Copayment/Coinsurance: This is the amount you pay each time you buy a prescription. This can vary from plan to plan. For example, in some plans you pay the same amount for any prescription while other costs will depend on the name of drug and whether or not the drug is a generic or brand name. Also, in some plans your share of the cost may go up when you pass an annual spending limit for drugs.

How do I enroll in a Medicare Part D Prescription Drug Plan?

You can compare local Part D plans and enroll right here on Medicare.com. Visit the link below to get started.

Apply for A Local Medicare Part D Plan Or;
Medicare Part D Information and Enrollment Center To Learn More

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