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Medicare Part D
Medicare Part B does not cover all the drugs you may need. To pay for prescriptions, you will need a prescription drug plan. There are a few options for prescription coverage within the USA. One of the options is a Medicare Prescription Plan – Part D.
Those with Original Medicare can look into supplemental insurance policies such as Medicare Part D. This plan covers various generic and brand name prescriptions.
However, if you already have a Medicare Advantage policy, you cannot pair that with a Medicare part D plan.
How does Part D work? What drugs will my plan cover? And, What are the costs of getting a Medicare Part D plan?
This article will answer those questions and more! Keep reading!
What Is Medicare Part D?
This insurance plan adds prescription drug coverage to your Original Medicare coverage. It allows you to get coverage for the prescriptions you need.
To get this plan, you need to have Medicare Part A, which is your hospital insurance, and/or Medicare Part B (Medical Insurance).
To get this plan, you must be a United States citizen or permanent resident.
Before you decide on a plan, ensure you understand how drug coverage works and confirm you do not already have coverage. Look into coverage from an employer, labor union, the Department of Veterans Affairs, and/or TRICARE.
If you do not have drug coverage from any of those sources, then consider a Part D plan.
How Does Medicare Part D Work?
Part D offers coverage in different tiers. The lower the copayment – the higher the tier. Each tier will be priced differently.
Each plan is required to cover the basic or “standard level” that Medicare has set. When applying for Medicare Part D, you can choose from various carriers offering different coverage levels.
Before choosing your plan, check what drugs the plan covers. Ensure the plan and tier you are considering will cover your prescription drug needs. If your prescription drug is not covered in your tier, your health care provider may request an exception from your insurance provider.
Your premium is affected by a few different factors. Certain individuals with Medicare pay higher premiums due to their income. Your Part-D premium may be calculated based on the previous year’s tax return.
Your yearly deductible should be capped at $445 in 2021. Certain Medicare Part D plans do not charge any deductible. Check the deductible of your plan before you finalize your purchase.
What Does Medicare Part D Cover?
The Medicare Part D plan covers a variety of drugs. If you know the specific prescriptions you need to be covered, you can check each option to ensure it will cover your medications.
Usually, the Part D plans have a list of covered drugs. This list is called a formulary. You can ask to check the formulary. Brand names and generic coverage can be included.
If the formulary does not cover your specific drugs, check to see if a similar option or alternative is offered.
Beware: your provider can change the formulary and/or remove a drug from the list. Your plan should notify you at least 30 days before the drug is no longer covered. And they may provide notice of the change when you request a refill and a month’s supply of the prescription.
Coverage Gap Or “Donut Hole”
In the coverage gap or “donut hole,” you start to pay more for your drugs out of pocket. This cost is limited. It includes all coinsurance, copayments, and prescription out-of-pocket payments. Your premium is not included in this limit.
In 2021, the coverage gap limit is $4130, and once that limit is reached that’s when Medicare Part D starts to pay 100% for the drugs. The upper limit of coverage does not apply to those who do not require expensive medications and are relatively healthy.
Takeaways
If you need prescription drug coverage and already have Original Medicare, then Part D is for you. Part D covers a variety of drugs and can help you get the prescriptions you need.
Compare your provider options to ensure you get the best value for your money.
Work with a knowledgeable and licensed independent agent at Meta Senior Insurance who has access to multiple carriers and can provide a detailed comparison. Give us a call at 603-696-4394 or 1-833-META-T65 for a free comparison.
References:
- Drug coverage (Part D) | Medicare
- How to get prescription drug coverage | Medicare
- What Medicare Part D drug plans cover
