Medicare Part D

Medicare Part D is a type of Medicare plan that’s sold by private insurance companies approved by Medicare. It provides prescription drug coverage and is purchased by many Medicare enrollees. 

Part D provides a comprehensive prescription drug service for outpatient needs. It covers the costs of prescription medication available at local pharmacies, mail orders, and other centers. To get prescription drug coverage, you can either buy a Medicare Advantage plan that includes it, or purchase a standalone Medicare Part D plan. 

To qualify for Part D, you must have enrolled for either Medicare Part A or Part B. Part D plans have different plans, each with different coverage options and rates. The cost of each plan is determined by the type of prescription medications it covers, the enrollee’s income, and other benefits offered by the plan. Generally, the higher your income, the more you’ll pay.

What Does Part D Cover?

Part D coverage varies depending on the plan and the insurance company. However, all Part D plans have a list of the prescription drugs they cover — known as the formulary. This formulary contains all the prescription drugs covered by a Part D plan under different groups. It’s important to carefully check the plan to ensure it covers the medications you need before making a decision.

Part D providers are required by Medicare to include certain types of prescription drugs in their Part D plans and at least two prescription drugs from the most prescribed categories. All Medicare Part D plans must cover HIV medications, antipsychotics, cancer treatment drugs, antidepressants, anticonvulsants, and immunosuppressants. However, Part D formularies do not contain dietary supplements, hair loss treatments, weight control drugs, and over-the-counter medications.

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Part D Tier System

All Part D plan formularies have a tier system through which drugs are classified. The tier system includes the type of drugs the plan covers and how they’re grouped by cost. Part D plans may have differing tier systems and may contain different prescription drugs. Usually, Tier 1 contains the preferred generic medications, which are the cheapest prescription drugs, while the highest tier contains specialty prescription medications. These types of prescription drugs are costlier than generic medications. All Part D plans have a mixture of generic and brand name prescription drugs.

Part D Cost

There are some factors that affect the cost of Part D plans. Some Part D plans may have $0 deductibles while some may have a high deductible depending on the type of medication and other factors. Part D enrollees must pay plan premiums, copayments, and coinsurance costs to continue their coverage. Since the coverage may change each year, this also affects the plan’s cost. Other factors which affect the cost of Part D plans are:

  • Location
  • Income, and
  • The type of medications covered by the plan

The eligibility requirements for Part D are the same as Medicare Part A and Part B. The Annual Enrollment period for Part D starts on October 15 and ends on December 7. 

Note: People with a limited income may have trouble affording Part D coverage. In this case, they may qualify for the Part D Extra Help Program — helping low-income beneficiaries with their Part D costs.

Get Help with Part D

Part D plans can help you manage the rising costs of prescription drugs. However, choosing a Part D plan is something that must be done carefully. Our agents are here when you need us. For assistance with Part D and other health insurance plans, contact Better Place Insurance Group in Lakeland, Florida.