Medicare Part D

Medicare Part D provides coverage for prescription drugs and is sold by private insurance companies approved by Medicare. Most Medicare beneficiaries purchase prescription drug coverage as an addition to their coverage plans. 

You can get prescription drug coverage through a Medicare Advantage plan or a separate Part D plan. Each prescription drug coverage plan has different plan options and rates. 

To qualify for Part D, you must meet the same eligibility requirements as Medicare Part A and Part B. You can also enroll for Part D during the Initial Enrollment Period once you are enrolled in Original Medicare.

Cost

Prescription drug coverage plans have copayments, deductibles, and monthly premiums. The cost of a Part D plan depends on certain factors, such as location or income. There are Part D plans with high deductibles that can go up to $545, while some plans may have $0 deductibles. In 2024, the average premium is around $55.50 each month, but can fluctuate each year based on the changes in the plan formularies. 

Since 2011, higher income beneficiaries’ Part D monthly premiums are based on income. These fall under the same Income Related Monthly Adjustment Amounts (IRMAA) that you will see under Part B, but at different rates. Part D premiums vary from plan to plan and roughly two-thirds of beneficiaries pay premiums directly to the plan, while the remaining beneficiaries have their premiums deducted from their Social Security benefit checks. Regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare.

Due to changes in coverage options by the insurer, the cost of a prescription drug plan may fluctuate each year. People who cannot cover their Part D costs due to low income can get help with their Part D expenses through the Part D Extra Help program.

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Coverage

Each prescription drug plan includes a list of prescription medications covered under the plan. This list is known as the plan formulary. Medicare mandates Part D providers to offer coverage for at least two prescription drugs found in each class or category. 

Generally, Part D plan formularies must also cover antidepressants, cancer treatment drugs, anticonvulsants, immunosuppressants, antipsychotics, and HIV/AIDS medications. However, Part D plans do not offer coverage for hair loss treatments, cosmetic treatments, dietary supplements, and weight control drugs. 

Each Part D plan has a drug tier system used to categorize the prescription drugs into groups. The lowest tier generally contains generic medications, while the highest drug tier includes specialty drugs. The higher the tier, the more costly it becomes. However, all Part D plans cover both generic and brand name medications. 

Before you enroll for a Part D plan, it is crucial to confirm if the plan covers the prescriptions you need. At Lifetime Medicare Partners, we can help you get the best Part D plan for your prescription drug needs. Contact us today for more information.