About Medicare Part D
A Medicare Part D Prescription Drug Plan helps cover prescription drug costs and other Medicare components. Enrollment can begin when an individual is eligible for Medicare. It’s critical to make sure participants are enrolled within their initial enrollment period to avoid a permanent premium surcharge.
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Medicare Part D Coverage and Enrollment
When Can I Enroll in a Medicare Part D Prescription Drug Plan?
Enrollment for Part D plans is especially time sensitive if a covered individual does not have similar drug coverage from another source, such as a retiree plan.
If the individual is already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, they can switch plans during the open-enrollment period, which runs from October 15 to December 7 every year.
What Does Medicare Part D Cover?
Medicare Part D drug plans are required to cover a wide range of drugs that are commonly needed by people on Medicare. This includes most drugs in protected classes such as those used to treat cancer or HIV/AIDs. A plans list of covered drugs is called a formulary. Each plan has its own formulary.
Most formularies are broken down into tiers. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. There are several factors that determine the actual cost of a drug to the policyholder. These factors may include:
- Whether the drugs prescribed to an individual are included in their plan’s formulary
- The tier that drug falls into in the formulary
- The pharmacy the policyholder uses, and whether or not the pharmacy offers preferred or standard cost-sharing, is out of network or is a mail order pharmacy. Out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with the plan to charge less.
- The current drug phase of the policyholder, for example, if they’ve met their deductible or are in the catastrophic coverage phase
- Whether they get Extra Help paying their drug coverage costs. Learn more about Extra Help here.
Financial Help for Part D Premiums
Individuals with annual incomes of less than $18,210 and financial resources of less than $14,100, or married couples with incomes of less than $28,150, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
As of January 1, 2021, Medicare Part D policyholders requiring insulin may be eligible for savings through their Medicare drug coverage. The cost for insulin could be no more than $35 for a 30-day supply.
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Have questions about enrolling in Medicare health insurance plans? Let us help. Contact us through this form or by calling 888-888-7511, and we’ll connect you with a licensed agent.
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