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Medicare Part D

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Medicare Part D

(Prescription Drug Coverage)

 
​Medicare Part D is prescription drug coverage. It is optional, in addition to Original Medicare.  If you are eligible for Part A and/or enrolled in Part B you may choose to enroll in a Part D plan.   Everyone eligible for Medicare Part A is automatically eligible for Medicare Part D. 

 

If you decide to enroll in this coverage, you will be responsible for paying monthly premiums as well as a yearly deductible. Specific coverage options and costs depend on the plan and provider you choose. 

 

Original Medicare does not cover prescription coverage; therefore, you must purchase a Part D plan though a private insurance company as a standalone drug plan and it covers both generic and name-brand drugs.

 

You may choose to add this plan to your Original Medicare coverage, or you may receive this through your Medicare Advantage plan. 


If you are considered low-income, you might be eligible for lower or no-cost plans, including Medicaid.

 

It is important to have prescription drug coverage even if you don’t take a lot of prescription drugs; in many cases, as people get older, they tend to have an increased necessity for prescription drugs. Therefore, it is better to be covered should the need for prescription drugs arise. 

 

 


Medicare Part D (Medicare Prescription Drug Coverage or PDP) helps cover prescription drugs and may help lower your costs and protect against higher costs in the future.  Anyone with Medicare Part A and/or Part B can join a Medicare Prescription Drug Plan offered in your area. If you are in a Medicare Advantage Plan, your plan may also offer drug coverage.
Source: Center for Medicare and Medicaid Services (CMS)


You may get your Medicare prescription drug coverage either from a Part D plan or a Medicare Advantage Plan offering Medicare prescription drug coverage.
 

Medicare Part D


Medicare Part D provides prescription drug coverage and it covers both generic and name-brand drugs. Everyone eligible for Medicare Part A is automatically eligible for Medicare Part D. 


You may add this plan to your Original Medicare coverage, or you may receive this through your Medicare Advantage plan. 


It is important to have prescription drug coverage even if you don’t take a lot of prescription drugs; in many cases, as people get older, they tend to have an increased necessity for prescription drugs. Therefore, it is better to be covered should the need for prescription drugs arise. 

When can you join a Medicare Part D Plan?
Enrollment starts between October 15th and December 7th – anyone can join, switch or drop a Medicare Part D plan. The change will take effect on January 1st so long as the carrier receives your request by December 7th.


You may join Part D within the seven-month period that begins three months before your birth month, your birth month when you turn 65, and ends 3 months after you turn 65.

If receiving Medicare due to a disability, you may join during the seven-month period that begins three months before the 25th month of disability which includes your 25th month of disability and ends 3 months after your 25th month of disability. You will be able to join 3 months before and after the month you turn 65.

Medicare Part D is prescription drug coverage. It is an optional, additional plan to Original Medicare and Medicare. If you decide to enroll in this coverage, you will be responsible for paying monthly premiums as well as a yearly deductible. 


If you are considered low-income, you might be eligible for lower or no-cost plans, including Medicaid.


Specific coverage options and costs depend on the plan and provider you choose. 


How Does Medicare Part D Work?

When choosing a Medicare Part D plan, you will have the option to choose one of five drug coverage lists known as formularies. A formulary is a list of prescription drugs that are grouped into certain categories, or tiers. These tiers are:
•    Tier 1: Low Copayment, Covers Preferred Generic Prescription Drugs
•    Tier 2: Slightly Higher Copayment, Covers Generic Drugs
•    Tier 3: A Bit Higher Copayment, Covers Preferred Brand Name Drugs
•    Tier 4: Higher Copayment, Covers Non-Preferred Drugs
•    Tier 5: Highest Copayment, Covers Specialty Drugs


To clarify, a copayment is a fixed amount you pay for a covered health care service after

you’ve paid your yearly deductible. For example, you may have to pay $20 out-of-pocket

for a certain drug.
Preferred drugs cost slightly less than non-preferred drugs because they are chosen 

specifically by your plan provider. If you need prescriptions outside of this chosen list,

you will have to choose a non-preferred plan.


What Should You Know About Medicare Part D?

When choosing a Medicare Part D plan, you will be faced with many likely unfamiliar terms. The list below includes important Medicare Part D terms you need to be aware of when searching for a plan:


•    Part B vs. Part D Prior Authorization Required (B/D): This drug may already be covered by your Part B plan.
•    Prior Authorization (PA): This drug requires your doctor’s approval before it is covered by your Part D plan.
•    Step-Therapy (ST): If your condition is treatable by two different prescriptions, you may be required to test one possible drug before the other drug is covered.
•    Dispensing Limit (DL): This means that your plan will not allow for more than a 31-day supply of this drug.
•    Limited Access (LA): This drug is only available at certain pharmacies. Speak with your doctor to find out if this drug is available in your area.
•    Retail Only (RO): This prescription is only allowed to be filled in-person at a pharmacy.
•    Retail and Mail (RM): This prescription may be filled at a retail pharmacy or through the mail.
•    Specialty Pharmacy Only (SP): This prescription must be filled out at a specialty pharmacy. Speak with your doctor to find such a pharmacy in your area.

 

Extra Help with Medicare Prescription Drug Costs/What is Extra Help?
 Extra Help is a program offered by Medicare for people with low incomes and limited assets. This is also called Low Income Subsidy or LIS. But less than half of the people eligible for Extra Help sign up. So, if you need help paying Part D premiums, deductibles and copays and think you might qualify, submit an application.


Do You Qualify for Extra Help?
 To be eligible for help with drug costs, you must:
 
•    Live in the United States or District of Columbia.
•    Qualify for Medicare Part A and/or be enrolled in Medicare Part B.
•    Have less than $19,320 in annual income2/$14,790 in assets (if single) (2021).
•    Have less than $26,130 in annual income2/$29,520 in assets (if married) (2021).

T White Insurance will help you better understand your Medicare coverage options. 

Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.

Important Information

If Part D is not selected during your initial enrollment, you may have a penalty for every month that you did not have creditable drug coverage.

Important Information

Medicare offers a Medicare Saving Program for individuals with a low or limited income.  If you qualify for this income-based program (Low Income Subsidy/Extra Help) you may be eligible to receive assistance with your Part B cost and/or your Part D premiums, but you must apply for the program.  

Visit: www.Medicare.gov/ExtraHelp for more information.  

T White Insurance can help with this process.

Important Information

When you are turning 65 and first eligible for Medicare you must enroll in Part D within your 7-month initial enrollment period or risk the chance of incurring a Late Enrollment Penalty. 

Filling Out Prescriptions
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