What is Medicare Part D Prescription Drug Coverage?

When weighing your options between Original Medicare, possibly with a Medicare Supplement, and Medicare Advantage, you may be wondering about Medicare Part D. Medicare Part D provides prescription drug coverage, and, similar to Medicare Advantage Plans, is provided by private insurers rather than the government. 

The Benefits of Medicare Part D

If you have Medicare Part A and Part B, you may be wondering if you need to enroll in Part D coverage. Signing up for Part D can be beneficial if you require prescription drugs that you take at home regularly, especially if their out-of-pocket cost is outside of your budget. Medicare Part D can help lower the cost of your medications, making them more affordable. This is especially helpful for individuals with limited or low income.  It is important to consider the fact that going without Part D coverage can possibly initiate a penalty for those that do not have another form of prescription drug coverage.

How Medicare Part D Works

There are two ways to sign up for a Part D Prescription Drug coverage plan: by enrolling in a standalone Part D plan (PDP)  or by enrolling in a Medicare Advantage with Prescription Drug coverage.

Enrolling in Part D by Selecting a Standalone Plan

If you are already enrolled in either Medicare part A or Medicare part B, you are eligible for a standalone Prescription Drug Plan.

Enrolling in a Medicare Advantage with Prescription Drug Coverage

Medicare Advantage plans combine multiple parts of Medicare into one plan — parts A, B, and often D. While most insurance providers offer prescription drug benefits with Medicare Advantage plans, not all do, so it is important to talk with a Medicare expert before enrolling.

To discuss coverage options specific to your needs, connect with a Medicare Specialist at PolicyZip by calling (844) 205-7510 or by filling out the form below. Additionally, see how to find savings on Medicare Part D Prescription Drug Coverage.

What Does Medicare Part D Cover?

Because there are many different kinds of Medicare Part D plans offered through private insurance companies, each will have its own list of medications it chooses to cover (called a formulary). Some plans may choose to cover expensive brand name medications with little cost passed down to you, while other provides may require you to switch to generic, alternative forms of a medication you need.

Like non-Medicare insurers, Part D plan providers often put medications into different tiers based on price. Medications in lower tiers are generally cheaper and drugs in higher tiers may cost you more out of pocket. One way to combat this is to ask your doctor if a generic medication or drug alternative in a lower tier is available.

Every Part D provider determines what medications and prescriptions they will cover, so it is important to ensure that your medication needs can be met before enrolling in a plan. Many plan search tools will allow you to input your prescriptions to determine if that plan will cover it and how much of the cost they may handle.

Paying for Your Drug Plan

Unlike Medicare Part A, Part D prescription drug coverage doesn’t come free. Depending on the plan you pick, you will likely pay a monthly premium for your drug coverage. If you are enrolled in Original Medicare, this will be in addition to your Plan B premium. Beneficiaries with a Medicare Advantage and Prescription Drug plan will also likely pay for drug coverage, though your premium will be for your entire Medicare Advantage plan, in addition to your Plan B premium.

Beyond your out-of-pocket premium, you will likely also pay a prescription deductible and a portion of the medication cost. Every deductible and out-of-pocket portion will vary by plan, but they generally work the same: you’ll pay for your drug costs until reaching your pre-determined deductible. From then, insurance will cover most of your drug costs and you will pay the remainder.

Getting Help with Prescription Medication Costs

Sometimes, even with insurance, the cost of prescription medications can be out of reach. For those with tight budgets and low or limited income, the choice between paying for groceries, rent or medication can be a difficult one to make.

If you find that you can’t pay for prescription drugs even with help from insurance, there are options. Programs like Extra Help (link to eligibility.com EH page here) are meant to provide aid in situations where you can’t afford a medication. Extra Help evaluates your level of need and can pay a portion or most of your mediation costs.  Still, there are other resources to explore if you don’t qualify for Extra Help, such as state assistance agencies and charitable organizations that specifically provide aid in covering medication costs. Some pharmaceutical companies will even offer discounts on their medications, specifically in cases where there is no generic or low-cost alternative available.

Be Aware of Penalties

All Medicare beneficiaries are encouraged to have creditable drug coverage, whether that is through their employer, a private plan, or Medicare Part D. In fact, if a beneficiary lacks creditable coverage, and then decides to enroll in a Medicare Part D plan, they may be liable to pay a penalty. This penalty is calculated by multiplying 1% of the national base beneficiary premium by the number of full months that the beneficiary went without creditable coverage. This penalty is added to your Part D premium each month and remains for the entire duration of your coverage. This can end up costing some beneficiaries hundreds, if not thousands of dollars. To ensure you do not face a penalty, speak with a Medicare expert here at PolicyZip by calling (844) 205-7510 or by filling out the form below.