- Medicare Plans
WHAT IS MEDICARE PART D?
Table of Contents
Original Medicare doesn’t offer coverage for many prescription drugs that may be prescribed by your doctor. Medicare Part D gives you the choice to add prescription drug coverage to your Medicare policy. While some Medicare Advantage policies may include prescription coverage. Part D plans allow you the choice to buy stand-alone drug coverage to your Medicare benefits.
Medicare Part D Eligibility
Most people who are eligible for Original Medicare are eligible to enroll in Medicare Part D.
- You are qualified/enrolled in Medicare Part A and Part B.
- You’re a US citizen
- You live in the plan’s service area.
Part D plans are administered by independent insurance companies, so there may be limits to where some plans can be bought and some benefits can be usedt . Like health coverage you may have held in the past, Part D plans also have local and national networks of preferred pharmacies and providers.
hich they offer coverage. Part D plans are provided by different insurance companies, so each plan’s formulary may offer different types of prescription drug coverage.
But, because Part D plans are a Medicare product, all policy options are required to cover almost all drugs within these protected classeshich they offer coverage. Part D plans are provided by different insurance companies, so each plan’s formulary may offer different types of prescription drug coverage.
But, because Part D plans are a Medicare product, all policy options are required to cover almost all drugs within these protected classeshich they offer coverage. Part D plans are provided by different insurance companies, so each plan’s formulary may offer different types of prescription drug coverage.
But, because Part D plans are a Medicare product, all policy options are required to cover almost all drugs within these protected classes
- HIV/AIDS treatments
- Antidepressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant medications
What does Medicare Part D cover?
All prescription drug plans have a list of drugs both generic and name brand, called a formulary, for which they offer coverage. Part D plans are provided by different insurance companies, so each plan’s formulary may offer different types of prescription drug coverage.
But, because Part D plans are a Medicare product, all policy options are required to cover almost all drugs within these protected classes
- HIV/AIDS treatments
- Antidepressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant medications
- Anti-cancer drugs (unless covered by Medicare Part B).
All Medicare Part D policies offer different prescription coverage options and exclusions. It’s important to make sure to check your list of medications against the prescription drugs covered on a plan’s list. Be sure to work with a trusted advisor to find the prescription drug coverage that is right for you.
WHAT DOES MEDICARE PART D COVERAGE LOOK LIKE?
Annual Deductible
Some plans may have an annual prescription deductible. The deductible is what you will pay out of pocket for your drugs before your plan begins to pay. Though many drug plans may offer coverage with no deductible, no Medicare drug plan may have a deductible more than $435 in 2020.
Prescription Costs
A plan’s drug formulary may be broken down into different categories called tiers. Drug tiers are how we divide prescription drugs into different levels of cost. There is a standard level of coverage that all Part D drug plans must provide, but plans can differ in how they structure the tiers of drugs in their formulary.
Typically, drugs in a lower tier will cost less than drugs in a higher tier.
| Tier 1 | Tier 2 | Tier 3 | Tier 4 |
|---|---|---|---|
| Generic | Brand Name | Preferred Brand | Specialty |
WHAT ISN’T COVERED?
Certain drugs aren’t covered with Medicare. Each Part B plan offers different benefits options and exclusions, so it’s important to understand your policy options. Generally, Medicare will not provide coverage for medications prescribed for:
- Anorexia
- Weight loss, or weight gain
- Symptomatic relief of cough and colds
- Hair growth
- Sexual or erectile dysfunction
We’re Here to Help!
Part D prescription drug coverage depends on each insurance company and each plan. Schedule an appointment with one of our advisors today to fund the best rated Medicare Part D plans for you.
PRESCRIPTION DRUG COVERAGE- PREMIUMS AND COSTS
The monthly premium cost for Part D prescription policies may differ across plan options.
-Most Part D plans charge a monthly premium that varies depending on the plan. These premiums are paid in addition to your Medicare Part B premium.
MORE COSTS AND CONSIDERATIONS
Income Related Monthly Adjustments- Though Part D premiums are paid directly to your insurance provider if your modified adjusted gross income is above a certain amount,
you may pay a Part D income-related monthly adjustment amount (Part D IRMAA).
This cart can be left out because it is a lot of information, but if we leave it in, can the design team make it pretty?
If your filing status and yearly income in 2018 was
| File individual tax return | File joint tax return | You pay each month (in 2020) | File married & separate tax return |
|---|---|---|---|
| $87,000 or less | $174,000 or less | $87,000 or less | your plan premium |
| above $87,000 up to $109,000 | above $174,000 up to $218,000 | not applicable | $12.20 + your plan premium |
| above $109,000 up to $136,000 | above $218,000 up to $272,000 | not applicable | $31.50 + your plan premium |
| above $136,000 up to $163,000 | above $272,000 up to $326,000 | not applicable | $50.70 + your plan premium |
| above $163,000 and less than $500,000 | above $326,000 and less than $750,000 | above $87,000 and less than $413,000 | $70.00 + your plan premium |
| $500,000 or above | $750,000 and above | $413,000 and above | $76.40 + your plan premium |
Late enrollment penalty- Medicare Part D coverage is an optional benefit. But, there may be financial penalties if you do not enroll in a Medicare Part D policy when you are first eligible for Medicare. Late enrollment penalties depend on how long you went without Part D or creditable prescription drug coverage, and in general, you have to pay this penalty for as long as you have a Medicare drug plan.
Gaps in Drug Coverage– The “donut hole” is another name for your Part D plan’s coverage gap. In all Part D plans, there is a limit on coverage after you and your insurance provider combined have spent a certain amount. When you reach this limit, you enter the” donut hole” and will pay more for your prescriptions. ….. Click here to learn more about gaps in coverage