Medicare Part D: Affordable Medication Plans
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Medicare recipients can receive prescription drug coverage through Medicare Part D. This protection will provide coverage for thousands of medications from pharmacies nationwide. We at Senior Market Agents Network can help you find the Part D coverage you need at an affordable cost.
What is Medicare Part D?
To millions of Americans, a critical aspect of their health care regimen is prescription medication. Unfortunately, Original Medicare (Parts A &B) doesn’t include Part D prescription coverage. Up until 2006, countless Medicare participants had to pay for their drugs with little or no help. That all changed with the creation of Medicare Part D.
Medicare Part D is prescription drug coverage for Medicare participants. It is a federal program managed through private insurance companies. Part D can reduce the cost of various drugs to much more affordable levels than their retail prices. Rather than paying triple digits for a prescription, Part D participants will likely only pay just a few dollars (or even $0) for most generics, and a modest share for many name-brand drugs. Rather than rely on your savings account to pay these costs, let Part D step in.
Who Qualifies for a Medicare Part D Plan?
Those who qualify for Part D Prescription Plans include:
- Medicare Part A and/or Part B coverage recipients
- Medicare Advantage (Part C) policyholders.
However, please note:
Certain plans are only available in certain areas. You must live in a Part D plan’s coverage to qualify.
Furthermore, to get a plan through your Medicare Advantage coverage, you likely will face a few other qualifications.
- You must live in the service area of the Part C plan.
- You must have both Part A & Part B coverage on the plan already.
- You cannot have end-stage renal disease in most cases.
- Some Medicare Advantage plans do not include or offer prescription coverage.
Check with your agent to determine your eligibility for a Part D plan.
When can I enroll in Medicare Part D?
Most people qualify for Medicare Part A & Part B upon turning 65 years old. However, since this coverage usually doesn’t include prescriptions, you’ll have to follow a more specific process to get Part D coverage.
- You generally should get coverage during your initial enrollment period (IEP) for Part D. This is the 7-month period around your 65th birthday when you first become eligible for Medicare itself. This is three months before your birthday, the month of your birthday and three months after your birthday.
- If you don’t enroll when you first become Medicare-eligible, you can also enroll during the annual election period (AEP). This period occurs annually from Oct. 15 to Dec. 7. You can use this period to enroll in Part D coverage, change or cancel your plan, or enroll in a Medicare Advantage prescription plan.
Keep in mind, if you do not enroll in Part D coverage when you first become eligible, you might have to pay a later enrollment penalty. Therefore, it’s almost always best to get covered when you first qualify for Medicare.
What types of Medicare Part D Prescription Drug Plans are available?
Most people get Medicare Part D coverage in one of two ways. Your course of action will depend on what type of Medicare plan you carry.
- If you have Original Medicare (Parts A & B), you can enroll in an original Part D plan through a private insurance company. You can enroll in any plan available in your area.
- Medicare Advantage plans (Part C coverage) often include prescription coverage. Under these private plans, you can get Original and prescription coverage from a major insurance provider.
Most people qualify for Medicare services upon turning 65 years old. As you reach that period, you’ll have a window of time in which to enroll in Original Medicare and Part D. Still, you do have options to enroll in Part D later, though you must meet qualifications to do so.
What are Medicare Part D Costs?
There are many Part D plans out there. You’ll have to pay a premium for coverage along with residual costs for the medication itself. It’s critical that you work with your insurance agent to select which policy works best for you.
Most Part D plans have 4 cost components:
- The Annual Deductible: It is your financial responsibility to pay the cost of the deductible each year. Part D’s 2018 deductible is $405. To meet the cost of your deductible, you’ll pay a network discounted price for your medication. After you meet the cost, you’ll enter initial coverage. Some plans reduce or waive the deductible.
- Initial Coverage: During initial coverage, you pay a co-payment for your medication. The cost will vary based on the tier of the drug covered by your plan. Most plans have multiple tiers. The higher the tier, the higher the cost. For example, a Tier 1 generic drug might only cost $7, while a Tier 3 drug might cost $40.
- The Coverage Gap: Your insurance company will track the spending on your plan until you have paid $3,750 for drugs (2018 cost). This is your initial coverage limit. After you reach this limit, you’ll enter the coverage lap. Within the gap, you’ll still pay discounted costs for your drugs, but will have more financial responsibility until you spend $5,000 in out-of-pocket costs (2018 cost). This gap is call the Donut Hole. Click for more information.
- Catastrophic Coverage: Once you reach $5,000 in costs, your plan will step in again. It will pay 95 percent of costs of your formulary medication for the rest of the year. This is particularly beneficial for people with expensive medications.
Some people never enter the coverage gap. Others use their plans through catastrophic coverage. Check with one of our agents to learn about your exact financial responsibility. Ask your doctor to help you choose affordable formulary drugs.
The team at Senior Market Agents Network wants to make sure you get the most effective Part D plan for your needs. Don’t hesitate to contact us today at 877-209-4949 for a policy quote or with questions about getting covered.
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”