Part D Prescription Coverage Table of Contents
- Why Buy A Part D Plan?
- Who Is Eligible For Part D
- When Can I Enroll In Part D?
- How Do I Get Enrolled?
- Where Do I Get Enroll In A Part D Plan?
- Prescription Discounts
Medicare pays about 80% of your hospital and doctor expenses, but they don’t pay for any part of your prescriptions, unless you are hospitalized. That’s why Medicare added Part D. A Medicare Part D plan is cheap coverage for prescriptions. It’s not required, but it’s foolish not to have it.
You are eligible for prescription drug coverage under Medicare Part D as soon as you are entitled to Medicare Part A and/or enrolled in Medicare Part B. You can get drug benefits through two types of private plans: a Prescription Drug Plan (PDP) that provides drug coverage only or a Medicare Advantage plan with prescription drug coverage (MA-PD), also known as Medicare Part C. About 66% of all Part D beneficiaries use the PDP-only option.
The open enrollment period, also known as the Medicare Annual Election Period, starts on 15 October and ends 7 December. If you are becoming eligible for Medicare because you are turning 65, you have an Individual Election Period (IEP) that starts three months before your birth month and ends two months after your birth month, giving you plenty of time to get signed up. If you are Medicare eligible due to a disability, you have a similar IEP starting on your 24th month of SSI.
You must affirmatively enroll in a Part D plan to participate; It’s not automatic. If you are eligible for Medicare and don’t enroll during the open enrollment period (or your individual enrollment period if you are just turning 65) you will have to pay a late-enrollment penalty (LEP) to use the benefit. The penalty is about 1% the average premium times the number of months that that you were eligible but not enrolled.
You enroll in Part D plan through an authorized Medicare insurance agent, through the plan itself, or through Medicare.gov. If you would like an independent agent recommendation, enter your zip code below to see a list of agents in your area.
All Part D plans are different. Each insurance carrier covers drugs differently. This is why it is so important to verify the cost and coverage of your prescriptions before you choose a plan. If you do not have regular prescriptions, then the lowest cost plan is generally safe. You can always switch at the next open enrollment.
All prescription drugs are not covered at the same level. There are five standardized tiers in each drug formulary, giving participants incentives to choose generics over brand name drugs. The lower-cost medications are assigned to lower tiers making plans easier to compare.
Be aware that a Medicare Part D Plan does not cover everything, and it’s only good for up to $2,850 of initial benefits (beginning of coverage gap). After that, you pay out of pocket until you become eligible for catastrophic coverage. For everything else, there’s the ScriptSave Discount Card. It even helps with pet medication discounts!