Medicare Part D: Prescription Drug Coverage
Medicare Part D is a prescription drug coverage program offered by private insurance companies approved by Medicare. These plans help lower the cost of prescription medications, including many commonly used drugs.
You can enroll in a Part D plan if you are eligible for Medicare Part A and/or Part B. It's important to enroll when you're first eligible. Delaying coverage may result in a late enrollment penalty unless you have other creditable drug coverage.
What is a Drug Formulary?
Each Medicare Part D plan has its own formulary, which is a list of covered prescription drugs. Formularies vary by plan and insurance carrier. They often include both brand name and generic medications. Drugs are grouped into tiers, with different cost-sharing amounts depending on the tier.
Before enrolling, review the plan's formulary to ensure it includes your medications. As a licensed agent, we can help you compare options to find the plan that best fits your needs and budget.
What Does Medicare Part D Cost?
The cost a Medicare Part D plan can vary depending on the plan you select, the medications you take, and your income. Here's what you may be responsible for:
- Monthly Premium: Each Medicare Part D plan sets its own premium amount. You can choose to have this premium direct billed, automatically deducted from you monthly Social Security or Railroad Retirement Board (RRB) benefit, or, in some cases, paid by credit card, depending on the plan's payment options.
- Annual Deductible: Some plans have a deductible, which is the amount you must pay before your plan begins to share in the cost of your prescriptions.
- Copayments or Coinsurance: After meeting the deductible (if your plan has one), you will pay a copayment or coinsurance for each prescription based on the drug's tier in the plan's formulary.
Coverage Stages That Affect Drug Costs
Medicare Part D plans have coverage stages that determine how much you pay for your prescriptions throughout the year. These stages apply to most plans and help you understand your potential out-of-pocket costs:
- Deductible Stage: You pay the full cost of your medications until your plan's deductible (if applicable) is met.
- Initial Coverage Stage: After meeting the deductible, your plan shares the cost of your prescriptions. You'll typically pay a set copay or coinsurance based on the drug's tier.
- Catastrophic Coverage Stage: Once your total out-of-pocket spending reaches a certain limit, you pay nothing for covered prescriptions for the rest of the year.
Need Help Navigating Medicare?
Understanding Medicare and choosing the right coverage can feel overwhelming, but you don't have to do it alone. As a licensed local agent, we can guide you through the process and help you make informed decisions about your healthcare and retirement needs.
We can help you:
- Understand your Medicare options and eligibility.
- Review plan costs, benefits, and coverage choices.
- Avoid late enrollment penalties.
- Find a plan that fits your health needs and budget.
Get personalized support from a trusted local professional. Call (414) 963-9412 today to schedule your no-cost, no-obligation consultation.
*Disclaimer: This page has not been reviewed or endorsed by Medicare.gov or any member of the Centers for Medicare & Medicaid Services (CMS).
