Medicare Part D is how Medicare refers to a Medicare RX plan. Everyone over the Age of 65 is required to have drug coverage. It can either be obtained from your employer, if you continue to work and that coverage is deemed creditable ( i.e. it is as good or better than what medicare says must be minimally offered.), or by purchasing a stand alone drug plan from an insurance company, or by purchasing a Medicare advantage plan that includes a drug plan.
Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. Your prescriber may think you need a drug that’s on a higher tier. If so, you or your prescriber can sometimes ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
- Provide written notice to you at least 60 days prior to the date the change becomes effective.
- At the time you request a refill, provide both of these:
- A written notice of the change
- A 60-day supply of the drug under the same plan rules as before the change
You’ll make these payments throughout the year in a Medicare drug plan:
- Yearly deductible
- Copayments or coinsurance
- Costs in the coverage gap
- Costs if you get Extra Help
- Costs if you pay a late enrollment penalty
Your actual drug plan costs will vary depending on:
- The drugs you use
- The plan you choose
- Whether you go to a pharmacy in your plan’s network
- Whether the drugs you use are on your plan’s formulary
- Whether you get Extra Help paying your Medicare Part D costs
Look for specific Medicare drug plan costs, or you can call me and I will help you find a plan that is right for you.
I am happy to meet in person to help you enroll or help you enroll online.
Don’t enroll without an agent.
If you enroll without an agent, and you have a problem, who will you call for help?
As your agent I can help you navigate the Medicare system and answer questions. Wouldn’t you rather call my personal cell phone for answers than wait on hold for someone who may or may not be able to help?
If you have limited income and resources, your state may help you pay for Part A and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage. I can help you with that as well.
If you turn 65 and do NOT have creditable coverage then you will begin to incur a late enrollment penalty.
The late enrollment penalty is an amount added to your Medicare Part D monthly premium.
You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:
- A Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C) (like an HMO or PPO)
- Another Medicare health plan that offers Medicare prescription drug coverage
- Creditable prescription drug coverage