Medicare Part D


Medicare Part D Prescription Coverage

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Medicare Coverages Are Like Learning The Alphabet, This is Part D

Medicare Part D medication coverage provides insurance to cover those medications not administered in hospitals or by a licensed physician in their office That is its sole function. Part D is different from A&B in that it is not provided by the government. It is in a stand alone program you get through the government but provided by a private company or as a part of Medicare Advantage Programs (Part C.)

Medicare Part D Prescription Coverage is Designed To:
  • Provide cost protection and medications for common ailments as well as medications in 6 specific categories.
  • Low premiums make these plans affordable as well as providing negotiated prices for drugs.
  • Work with traditional Medicare Parts A&B and are frequently included in Part C Medicare Advantage Plans

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Part D Eligibility And Enrollment

Medicare Part D plans are open for enrollment at the same time that you become eligible for traditional Medicare, currently three months before your birth month, your birth month and three months after in the year you reach 65. Certain disabilities and other health conditions may also make you eligible before 65.Though you need not enroll in Part D at that time, there is a penalty involved if you fail to do so and try to enroll outside of an open enrollment period.

If you fail to enroll initially there are two periods when you may enroll in Part D without penalty. Currently the Medicare Part D enrollment period, traditional Medicare and Part C Advantage Plans is from Oct 15th to Dec 7th. Known as the annual election or open enrollment period, you may change Advantage plans, switch back to or opt away from traditional Medicare and enroll in Parts B & D with no penalties. 

Though there is a Medicare Advantage Plan enrollment  From January 1 to March 31 where you may change Part C or return to traditional Medicare but not from Medicare to Part C you are not allowed to add a Part D or drop it now.

Special enrollment periods may allow you to enroll in  Medicare Part D Coverage plans see for qualifying events for special enrollment periods.

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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.

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