Medicare Part D

Medicare Part D Coverage:
Medicare Part D covers prescription drugs. With so many letters and acronyms I often tell my clients to simply think D for Drugs.

A part D plan can be added to original Medicare, or a Medicare Supplement plan. It can even be added to a PFFS MA plan, however most commonly it will be combined with a Supplement or original Medicare.

Many popular Medicare Advantage plans, also include prescription drug coverage. These plans are referred to as MAPD’s or Medicare Advantage Prescription Drug Plans.

Medicare Part D Formulary:
All Part D plans have what’s called a formulary. A formulary is basically a big list of medications that the plan covers. When looking at different plans, it’s important to ask you agent to run your drugs against the formulary of the particular plan you are considering, to make sure they are all covered.

Medicare Part D Premium:
Part D plans range in premium. Statistically the national Part D average in 2016 is $34.10. This not only gives you an idea Part D premium, but it is also used when calculating the Part D Penalty you will get in the event you don’t obtain creditable coverage when you start Medicare.

63 days after your IEP is over, if you do not have credible coverage, you will begin to be assessed a penalty of 1% of the national average times the number of months you do not have coverage. For more information on the Part D Penalty simply click here.

Medicare Part D Out-of-Pocket Cost:
Most Part D plans have a deductible and co-pays or co-insurance that is based on drug tiers. The deductible and co-pays can range depending on where you are located. Typically out-of-pocket cost for generics will be quite a bit less than name brand drugs. With most plan, you will pay your deductible and co-pay prior to hitting the coverage gap or Part D Donut Hole. If you hit the donut hole, you will pay a percentage of drug cost up to a certain amount. You may even reach the other side of the donut hole, called catastrophic coverage, if you take a lot of medications or have expensive medications.

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