Medicare Part D Prescription Drug Coverage

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Medicare Part D

Medicare Part D is the United States federal drug benefit program.  Part D is designed to help anyone on Medicare with their drug coverage.

medicare part d

who is eligible for medicare part d?

If you have either Medicare Part A or Medicare Part B, you will be eligible for Medicare Part D.

There are no exams that are required to qualify for Part D. You can’t be denied coverage because of preexisting conditions or if you already use prescription drugs.

how do i get medicare part d?

Part D plans are sold through private insurance companies. These insurers have contracts with the federal government which allows them to sell their drug plans to consumers like you. Part D plans are not sold by the government. How do you find the right Part D plan? You can use a broker or go directly to Medicare.gov.  

can you sign up for medicare part d anytime?

Most people should sign up for their Part D when they are eligible to enroll in Original Medicare. You are only allowed to sign up for Part D during specific enrollment periods.

These enrollment periods include:

  • Initial Enrollment Period: When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
  • Special Enrollment Period: The following are the most common Special Enrollment Period scenarios. However, there are more ways you can qualify. Let’s look at the most common situations:
    • You already have a Medicare Part D plan and change where you live.
    • You lose or drop your employer health insurance coverage.
    • Your plan changes its contract with Medicare. For example, Medicare terminates your current plan’s contract or Medicare doesn’t renew the contract.
  • Annual Election Period: Medicare’s annual election period is October 15th – December 7th. During this time, Medicare beneficiaries can change or sign up for a Part D drug plan.

how much does medicare part d cost?

The price that you’ll ultimately pay will often depend on your medications and what stage you’re in. 

Part D plans have 4 Stages

You may end up paying a different price for the exact same medication depending on the phase of coverage that you’re in during the year.

1. Deductible

Some drug plans have a deductible. If so, you’ll pay the full price for your medications until your deductible amount is satisfied. Your price boils down to what your plan has negotiated with the drug manufacturer. This full price may be lower than what you would have to pay retail at your pharmacy.

2. Initial coverage period

This refers to your share of drug costs for each prescription that is either a percentage or a flat copayment. The majority of Part D plans have several tiers of copays. These copays increase in cost from the cheapest generic drugs to preferred and non-preferred brandname drugs and finally to higher-cost specialty drugs.

3. Coverage gap

The coverage gap (frequently called The Medicare Donut hole) is the gap inside of your Medicare Part D drug plan. It’s the time when your Part D drug costs can be more expensive than they were before you reaching the coverage gap (donut hole). During this phase, the drug manufacturer covers 75% of the cost of your medications, and you are responsible for the remaining amount. 

4. Catastrophic level of coverage

Your share of each of your medications is approximately no higher than 5% of the cost of the medication. The price for your drugs may also be different if you receive Extra Help. The price could be different if you have additional coverage from another source like a retiree drug benefit or help from your state pharmacy assistance program.

Frequently Asked Questions

Medicare Part D is not mandatory. However, signing up will depend on your specific circumstances. Some people have creditable drug coverage from their retiree insurance or employer. For those people, they won't have to enroll in a Part D Plan until they lose that coverage. Another situation is with people who are already enrolled in specific low-income assistance programs. They may get enrolled automatically with a Medicare drug plan. They may also receive extra financial assistance that can pay for their medications.

You can change to a new Medicare Part D drug plan by signing up for another drug plan during one of these times.

  • Initial Enrollment Periods for Part D
  • Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.
  • Medicare Advantage Open Enrollment Period.

If you delay signing up for a Medicare Part D plan you may end up paying a penalty when you begin your plan. This penalty will stay and remain as long as you have Part D drug coverage.

You won't need to cancel your old Medicare Part D drug plan, because your old Part D plan will terminate when your new Part D plan begins.

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