Medicare Part D - Prescription Drug Coverage
Medicare Part D is the part of Medicare that pays for prescription drug coverage. If you are eligible for Medicare, you can sign up for a Medicare Part D plan. There are several plans to choose from and it is each individual’s responsibility to sign up for the plan that is best for them.
Choosing a plan will depend on several different factors. The most important thing to consider will be the types of prescription medications you are already taking. You will want to be sure the medications you need will be covered by the plan that you choose.
Each of the different Part D prescription drug plans use a formulary, or a list of medications they will or will not cover. Even if a specific drug is on the formulary, the cost to you will depend on which tier the drug falls in. Most drugs will fall into one of three tiers: generic, brand name and non-preferred.
Typically, generic drugs are the least expensive tier. Most plans will require you to use a generic drug if it is available. These medications have lower costs, therefore, lower co-pays.
Not all prescription medications are available in generic form. When your doctor prescribes a brand name drug, it will be available to you at the higher brand name co-pay. Depending on whether the medication is preferred or non-preferred will determine the exact cost to you.
There are other factors that will determine the cost of a particular medication. Some medications will be covered by the plan only if you have tried other less expensive alternatives and your doctor decides those medications will not work for you. In this case, the doctor has the option to call the insurance company and obtain a prior approval.
Yet another factor to consider when choosing a Part D prescription drug plan is the cost of premiums and deductibles. These costs will vary from plan to plan. Most plans will include a coverage gap commonly referred to as, “the donut hole”. This means there is a temporary limit on what the prescription drug plan will cover for drugs. It is important to note not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2021, once you and your plan have spent $4,130 on covered drugs, you’re in the coverage gap. (Note: This amount may change each year.)
The best way to choose a Medicare Part D plan that will work best for you is to take the time to do some research on each plan. You will have the option to change plans once a year during the Annual Enrollment Period (AEP) October 15 – December 7 should you find the plan you have is no longer beneficial to you. During this time period, Medicare Instructors hire seasonal staff to review prescription plan options for the following year. Should you prefer to do your own research, you can visit Medicare.gov and enter your prescriptions and locations to find prescription drug plans available in your area.
Medicare Instructors clients can expect a call from a friendly member of our staff during the Annual Enrollment Period (AEP) to offer a Medicare Part D plan review.
Calls are made between the dates of October 15 through December 7.