Medicare Part D
What is it? Medicare Part D is the optional prescription drug coverage available by private companies contracted with Medicare. If you have Original Medicare Part A and/or Part B, live in the service area, you can sign up Part D. Part D is optional, however, if you do not sign up when first eligible, you’ll likely pay a penalty when you enroll in a Part D plan. There are 2 ways to get prescription coverage:- Stand Alone Prescription Drug Plans. These plans, also known as PDP (prescription drug plans), can be work with Original Medicare (and a MediGap plan if you have one) to provide prescription drug coverage.
- Medicare Advantage Prescription Drug Plan, also known as MAPD. These Part C plans include your Original Medicare Part A and Part B benefits and add Part D prescription drug coverage along with additional benefits.
- Premium – this can vary upon formulary, deductible, coverage during the coverage gap.
- Formulary – can be basic or expanded
- Deductible – if there is one and how much it is, and which tiers apply to it
- Copay amounts
- Tiers – some plans may only have 4, others may have up to 6 tiers, each tier has a copay or coinsurance amount depending on the cost of the medication.
- Pharmacy – Retail vs. Standard. Costs at a retail (or in network) pharmacies will be cheaper than at standard pharmacies. Also, some plans may have lower costs thru mail order.
- Deductible – some plans have an annual deductible that you must meet before the prescription coverage starts.
- Coverage – once you meet the deductible (if there is one), you have a certain amount of prescription coverage. Every year this amount changes (click here for more information. ) When you fill a prescription, you pay a copay or coinsurance. Once the coverage limit is met you have used up your coverage
- Coverage Gap – (also known as the Donut Hole) is the phase of Part D when your copays and the share the insurance carrier has paid has exceed the Coverage limit set by CMS every year. In the donut hole you pay all the costs of your medication until you reach the annual limit. Once that happens you have gotten out of the donut hole. The donut hole will be closed by 2020, passed as part of the Affordable Care Act.
- Catastrophic Coverage – once you have reach this portion of Part D benefit, your costs are reduced substantially.
- Shop your Part D plan every year. Premiums, copays and formularies change every year make sure you are getting the right plan for your medications.
- Talk with your physician about lower cost medications
- Use retail or mail order pharmacies