Medicare Prescription Drug Plans in District of Columbia

Changes to 2022 Medicare Part D in District of Columbia

There are more District of Columbia Medicare Part D Plans (PDPs) in 2022 than in previous years. The bad news is that the maximum deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. is now up to $480 per year, an increase of $35 over last year. However, the Initial Coverage LimitOnce you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut... increased to a new high of $4,430. The following discussion will help you find the best Medicare prescription drug plan available in District of Columbia at a price you can afford.

The Maximum Deductible on 2022 Medicare Part D Plans

The deductible is the amount that you pay before your Medicare Part D plan begins paying its share of the costs. So, if you enroll in a 2022 prescription drug plan with a $480 deductible, you'll spend $480 out-of-pocket before cost-sharing coverage begins. Most Medicare Part D plans have a deductible, but many Medicare Part D plans exclude Tier 1 drugs from the deductible, giving immediate coverage on most generic medications.

2022 Medicare Part D Initial Coverage Limit

The 2022 Initial Coverage Limit (ICL) is $4,430. The ICL phase is when your Part D plan begins to pay the bulk of the costs. If your prescription costs exceed $4,430, you will enter the Coverage GapA period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. phase (aka, "donut hole").

Will You Fall Into The 2022 Donut Hole?

After your 2022 gross drug costs have reached $4,330, you will enter the Coverage Gap phase. This is where you will pay 25% of your medication's retail cost. While the price of generic drugsA generic drug is a prescription medication that has the same active ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. might not be much different, what you pay for brand-name drugs will be higher (because you're paying 25% of the full price). This will continue until you reach $7,050 in True Out Of Pocket Costs (TrOOP).

Some plans offer additional gap coverage, so look for it on the plan information pages.

Choose Your Part D Plan with Care

Don't make a decision on your choice of Part D Medicare plans based on the premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums.  and deductible alone. It's critical that you verify that your medications are covered. You find this information, and the co-payment tiers, in the formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. On each PDP page (above) we post links to the formulary and pharmacy web pages, and the phone numbers to contact the plan.

CRITICAL: The best Medicare Part D Plans for you can only be determined by factoring in what you can afford, your regular prescriptions and your health. A bit of time spent on research will pay off in the long run.

Did you Know Most District of Columbia Medicare Advantage Plans Include Prescription Drug Coverage?

There's more than one way to get prescription drug coverage with your Medicare benefits. The first way is by enrolling in one of the Medicare Prescription Drug PlansMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... listed above. The second way to get help paying for your prescriptions is through one of the District of Columbia Medicare Advantage Plans that include Part D.

Combining a Supplement and Medicare Part D Benefits

Thinking about supplemental insurance that can offer you more coverage? It's a smart move. Even with the new health care law, Medicare only covers 80 percent of the hospital and doctor bills incurred by most seniors in the great state of District of Columbia, leaving you to handle the rest. We make it easy to find the lowest price on the District of Columbia Medicare Supplement, commonly called a MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plan, you want. The choice is yours, because all Medicare Part D plans are compatible with District of Columbia Medigap plans.

Medicare Part D for Dual Eligible People in District of Columbia

If you meet the requirements for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. (aka, dual eligible or Medi-Medi) in District of Columbia, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium..., the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.

Frequently Asked Questions About District of Columbia Medicare Part D Plans

PDP Eligibility and Availability

You are eligible to enroll in a District of Columbia PDP plan if:

• You are a resident of the state,
• You are enrolled in Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services., and
• You are age 65+ or have Medicare due to a qualifying disability.

All plans on this page are available to beneficiaries in , and all rural areas of District of Columbia.

Related: Compare 2022 Medicare Part D Plans in District of Columbia

Citations & References

medicare.gov

• https://www.medicare.gov/plan-compare/
• What Medicare Part D drug plans cover | Medicare https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans...
• Medicare.gov: the official U.S. government site for Medicare | Medicare https://www.medicare.gov/

cms.gov

• https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGe...
• CMS 1696 | CMS http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS012207.htm...
• MACRA: MIPS & APMs | CMS https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instrumen...

kff.org

• An Overview of the Medicare Part D Prescription Drug Benefit | KFF https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-pr...
• Medicare Part D: A First Look at Prescription Drug Plans in 2020 – Issue Brie... https://www.kff.org/report-section/medicare-part-d-a-first-look-at-prescripti...
• 10 Things to Know About Medicare Part D Coverage and Costs in 2019 | KFF https://www.kff.org/medicare/issue-brief/10-things-to-know-about-medicare-par...

shiptacenter.org

• Home | State Health Insurance Assistance Programs https://www.shiptacenter.org/

The Medicare Part D information in this directory originates from CMS Landscape Source Files, is maintained by David Bynon and was last updated on February 7, 2022.