Medicare Part D - Plan Medicare

Medicare Part D

Is a drug program that helps pay for the costs of prescription drugs

Medicare Part D is offered by private insurance companies and approved by Medicare for eligible recipients. Individuals on Medicare are eligible for prescription drug coverage under a Part D Medicare plan if they are signed up for benefits under Medicare Part A and/or Part B.

How Do I Get Medicare Part D?

1.   An individual can purchase it as a stand-alone Medicare Prescription Drug plan (also know as PDP). Most people who purchase a stand-alone drug plan typically purchase it with a Medicare Supplement Plan, which does not include the drug coverage. The two are purchased separately.

2.   An Individual can get a Medicare Part D plan through purchasing a Medicare Advantage Plan Part C (also known as an MA-PD plan).

The costs for Part D Medicare will vary amongst which private companies’ plan you choose and what kind of drug are covered

How do I know if my drugs are covered?

Each Medicare Prescription Drug plan has its own list of covered drugs known as a formulary. The formulary is first organized by category or class of drug. The formulary is then divided up even further into tiers, for each prescription drug. The tier ultimately determines what an individuals co-pay or cost sharing amount will be for that particular drug.

Typically the private insurance companies will categorize the drugs offered into 5 different tiers

Tier 1 will most likely be a generic drug with the lowest copay while a Tier 5 will be a brand name medication with the highest copay. Each company also has partnerships with in-network pharmacies that will offer you better copays than going to an out-of-network pharmacy.

In addition each private insurance company will utilize a mail order service that will always be considered an in-network pharmacy that will also sometimes gives you a 3 month supply of medication for 2 months copay.

The licensed agents at Plan Medicare use a proprietary set of tools that can quickly look up a recipient’s prescription drug coverage and compare the copay amounts for each private insurance company. We can also determine what an individual’s annual out of pocket costs will be, including plan premiums, co-pays and cost sharing amounts.

We can compare all drug plans offered within a particular U.S. state side by side, to determine the most cost effective option for each individual. So, it’s important for individuals to truly evaluate the landscape to find the most cost effective Medicare Part D Plan.

Other important information about the Medicare Part D Program

  • You may be eligible for Extra Help or cost sharing assistance from the government if you meet certain income requirements.
  • The Part D monthly premium varies by plan (higher-income consumers may pay more).
  • It is possible to have your Part D premium automatically deducted from your monthly Social Security/Railroad Retirement Board benefit check.
  • A late enrollment penalty can be added at any time after your initial enrollment period (IEP) unless you have creditable drug coverage (ie: an employer sponsored plan).
  • You can enroll into a Part D plan by calling 1-800 MEDICARE directly, go straight to a private insurance carrier or work with an agent who can help guide you to a plan that fits your specific needs.
  • You cannot have a Medicare Advantage Plan (Part C) and separate Part D prescription drug plan at the same time.
  • Review your Medicare drug plan every year, as plan formularies can change.
  • You are eligible to change, add or drop your Part D plan during the Open Enrollment Period every year (OEP)(AEP).

Some Medicare drug plans have a coverage gap also known as “the donut hole” which means that after you and your drug plan have spent a certain amount of money for covered drugs, you may have to pay more for your prescription drugs, up to a certain limit.