Lower prescription drug costs with Medicare Part D.
A Medicare Part D plan is prescription drug coverage that is an optional benefit available to everyone with Medicare. Part D coverage can reduce your out-of-pocket costs for the prescription drugs you may need. Without this important coverage, prescription drugs can be costly.
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Medicare Part D Essentials
Medicare Part D covers just one type of medical expense: prescription drugs.
Part D plans are offered by private insurance companies that contract with Medicare.
Part D plans can be purchased as a standalone plan to supplement Original Medicare (Parts A and B) or to accompany a Medicare Supplement Plan.
As you research your options for prescription drug coverage, consider the following:
- Medicare Part D is an optional program, but without it, you could pay a lot for the medications you need. If Original Medicare will be your primary coverage, you should enroll in Part D when you first become eligible at age 65.
- Many Medicare Advantage (Part C) plans provide drug coverage. If you have one of these plans, you may not need Part D.
- Be sure to choose a Part D plan with a formulary (list of covered drugs) that offers the medications you need.
- The cost of prescription drug coverage varies depending upon the plan you choose, the medications you take and if your pharmacy is in network.
- Generally, drug plans that charge a deductible up front will have lower monthly premiums and lower copays.
Four Stages of Prescription Drug Coverage
All Part D plans have four stages and Medicare sets the limits for each of these stages during the year.
Companies can offer benefits that are greater than the minimum standard but not less than that standard.
Stage 1
Deductible
During this stage, you’ll pay the plan’s full negotiated drug cost out of pocket until you reach the plan’s deductible. (Some plans have a $0 deductible, which means you’d skip this phase.) Once you’ve met the deductible, you’ll pay a copayment or coinsurance in the next stage, Initial Coverage.
You pay 100%
Stage 2
Initial Coverage
In this stage, you’ll pay a copayment or coinsurance for each prescription you fill until the amount spent by you and your insurance company totals the annual limit set by Medicare. Most people remain in this stage.
You pay copay/coinsurance
Stage 3
Coverage Gap
In this stage (also known as the donut hole), you’ll pay 25% of the cost for generics and brand name drugs. Once your yearly out-of-pocket costs are reached, you’ll move to catastrophic coverage.
You pay 25% for brand and generics
Stage 4
Catastrophic
In this phase, you’ll pay only a small copayment or coinsurance amount for each prescription you fill through the end of the year. Few people will reach this stage.
You pay copay/coinsurance
An extra charge for higher earners
If you have a higher income, you may have to pay an extra amount in addition to your plan premium. Known as an income-related monthly adjustment amount (IRMAA), it’s a surcharge based on your modified adjusted gross income on your tax return from two years prior. To get a better idea of what your cost could be, click the Shop Our Plans button below.
Extra Help for people with limited income
Medicare offers an Extra Help program to help people with limited income and resources pay Part D premiums, deductibles, coinsurance and other costs. To qualify for Extra Help, you must have an annual income that falls below 150% of the federal poverty level based on your household size. Let us help you determine if you qualify, click the Shop Our Plans button below.
Enrolling in a Medicare Part D plan.
- You’re eligible to enroll in Part D when you first get Medicare. This Initial Enrollment Period (IEP) lasts seven months. It includes the three months before you turn 65, your birth month, and the three months following.
- If you already have creditable drug coverage through your employer’s health plan, you can delay enrolling in Part D. When you’re no longer covered by your employer’s plan, you can enroll in Part D during a Special Enrollment Period, provided you can show proof of creditable coverage from age 65 through your Medicare start date.
- Once you’re enrolled in Part D, you can change plans during the annual Open Enrollment Period, October 15 – December 7.
The best way to get started
Now that you have a general working knowledge of Medicare Part D, let’s get shopping for your best plan. Don’t worry, we’re here to help you every step of the way. Just click the link below and we can continue the journey together.