Medicare Part D Coverage
Medicare

Understanding Medicare Part D Coverage

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What Is Medicare Part D Coverage?

Medicare Part D insurance coverage is designed to provide affordable access to prescription drugs and medication. Medicare Part D is a standalone plan separate from parts A and B (hospital insurance and medical insurance, respectively) and is provided by private insurance providers but regulated by Medicare. 

Medicare Part D prescription coverage is optional if you have creditable coverage elsewhere. 

Medicare Part D Coverage and Enrollment: What You Should Know?

Easy, affordable access to medication is essential for good health. Unfortunately, roughly 58 million Americans forgo getting prescriptions filled because of the high-cost, and this is a decision that could prove life-threatening. 

No one should have to choose between the medication and the money they need to survive. Medicare Part D coverage is one way in which the federal government tries to make prescription medication more affordable to people who qualify for Medicare. 

We’re going to tell you more about it here, so keep reading. 

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Who Qualifies For Medicare Part D Coverage?

Medicare Part D covers those with the following qualifiers:

  • If you’re aged 65 and over
  • Anyone that qualifies for Medicare
  • Those that qualify for Extra Help due to low income
  • If you lose prescription drug coverage from a source like an employer, Veterans Affairs, a union, etc. 
  • If you return to the U.S. from living abroad
  • If you’ve been released from prison

Note that there are some factors that affect coverage and some restrictions. For example, if you’ve just returned to the U.S. or have just been released from prison, you only have two months to sign up for Medicare Part D coverage. Enrolling as soon as possible is your best bet to ensure you have coverage and aren’t charged late penalties. 

What Medicare Part D Covers?

Medicare Part D is set up in order to give everyone over 65 (as well as those with special circumstances) access to reliable, affordable prescription drug coverage. Medicare Part D covers medications for common ailments and specific categories, with negotiated rates regulated by Medicare. It covers both generic and brand name prescriptions, depending on the plan and drug.

Each plan is different. Some drugs may or may not be covered, some plans will force you to use the generic brand of the drug or a cheaper version of the drug before trying the name-brand version. Understanding the restrictions of your plan will help ensure you never go without the coverage or drug you need.

How to Get Medicare Part D Prescription Coverage?

Medicare Part D coverage is available to you in two ways:

  1. Through a Medicare drug plan. You need to have Part A and Part B coverage in order to get a Medicare Part D drug plan. 
  2. Through Medicare Part C, also known as Medicare Advantage. This gives you everything from Parts A and B plus more in one convenient plan.

It’s worthwhile to note that you can’t get Medicare Part D coverage without also having Parts A and B.

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Medicare Part D Enrollment

Medicare Part D enrollment isn’t overly complicated, but it is important to do it correctly and on time to avoid paying a penalty. 

Enrolling in Medicare Part D coverage is as simple as contacting the plan provider you choose and requesting enrollment. They will walk you through all the steps required in order to have Medicare Part D creditable coverage.

The period to enroll depends on how you qualify for Medicare:

If you’re qualifying due to your age, this counts as your initial enrollment period and it occurs for seven months (three months leading up to your 65th birthday month, your birthday month itself, and the three months after your birthday).
If you qualify for a special enrollment period, then the enrollment period is different. For example, if you qualify for Extra Help, you can enroll or switch plans any time of year. But if you lose creditable coverage from elsewhere (like an employer or union), you have just two months to sign up for a new Medicare Part D drug plan.

Enrolling for Medicare Part D coverage outside of these periods is not usually possible, no matter how urgently you may need coverage for medication. If you don’t sign up during these enrollment periods, there are two consequences:

You can’t sign up again until the next open enrollment (October 15th to December 7th, with coverage starting January 1st).
You may be subject to late enrollment penalties for the rest of the years that you pay for Medicare Part D coverage. This penalty depends on how long you were without Medicare Part D coverage or another creditable prescription drug coverage from age 65 on.

So, it’s clear that it’s very important to enroll on time, both to avoid late penalties and to ensure you have the coverage you need or could potentially need. When you’re ready to enroll in a plan, have your Medicare number handy as well as the date your coverage began to ensure seamless enrollment.

Choosing Medicare Part D Coverage Plans

While enrolling may be simple, choosing a plan can be a little more complicated. After all, you want to make sure the plan is right for you and your prescription drug needs. There are many different plans out there to choose from, but the right plan will:

Cover the prescription drugs you need at the dosage/frequency you require
Be in your service area
Have the lowest possible copay/deductible

Plans can vary widely, especially in terms of copay. To find the best possible plan for you, visit Medicare’s Plan Finder tool. This online tool allows you to enter the prescription drugs you need coverage for, find pharmacies covered near you, figure out your total out-of-pocket costs, and so much more. 

You can also get a free Medicare Plan D quote from us. We’ll match you with the best plan for what you need and where you live. Request a quote now. 

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The Best Medicare Part D Coverage For You

The good news is that if you’re not happy with a plan, you can easily switch each open enrollment period to find a plan that works better for you. This is particularly useful in case your medications change or a new plan comes out. 

If you’re not sure which plan is right for you, you also have resources at your disposal to help:

Call Medicare’s Helpline to get assistance with your plan search.
Contact your state health insurance assistance program (SHIP) for assistance and guidance from trained Medicare advisors.
Visit local senior centers for help in person or virtually.
If you have a plan in mind or you’re no longer sure about your current plan, contact the insurance provider directly for any clarification/questions.

Finding the right plan for you is critical and it makes sense to shop around for new plans regularly, if not annually, in order to find the right fit. 

In Brief: Medicare Part D Coverage Plans

Medicare Part D coverage plans are designed to help ensure more people have affordable prescription drug coverage. For many, prescription medication can be the difference between life and death, and so having the right coverage in place helps protect us all. And with negotiated drug prices and premiums, coverage can be affordable and accessible, no matter where you live. 

Questions?
Most plans have a yearly deductible that must be met before you begin to receive the full benefit of your part D coverage. The plan then pays up to a specified limit when it reaches a plan designated coverage limit. This coverage gap (donut hole) remains until you pay the out of pocket limit at which time the Part D bears the bulk of the cost. Each plan is different and some have no coverage gap.
All Medicare prescription coverage Part D plans have a formulary and each may be different. It is a listing of drugs that are covered in that plan. Not every drug will be in every formulary but it generally will contain a medication of that type if not the exact one you use. They can change yearly and you should check to make sure your type of medication is listed.

Currently stand alone Part D Plans on average have a premium of $42. This can vary by state and region. Get a Medicare Part D quote here at ConsumerCoverage. It should also be noted that many Part C Medicare Advantage Plans include Part D coverage in their plans.
Medicare Part D coverage is prescription drug coverage, designed to be a standalone plan offered by private insurers and regulated by Medicare.
For the initial enrollment period and annual open enrollment, you can enroll from October 15th to December 7th, with coverage beginning January 1st. Otherwise, special enrollment periods will vary depending on the circumstances.
To enroll, you can contact Medicare or the plan directly, via phone, mail, online, or in person. You can also enroll using Medicare’s online Plan Finder.

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