Medicare Part D: Prescription Drug Coverage
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Medicare Part D provides outpatient prescription drug coverage. It is offered through private
insurance companies approved by Medicare.
Key Features of Part D:
- Optional:You can choose to enroll in a Part D plan or get drug coverage through a
Medicare Advantage plan (Part C) that includes drug coverage.
- Monthly Premiums:You pay a monthly premium to the private insurance company, in
addition to your Part B premium (if applicable).
- Formulary:Each plan has a list of covered drugs (formulary).
- Coverage Gap (Donut Hole):There's a temporary coverage gap where you pay more for
your drugs after you and your plan have spent a certain amount.
- Catastrophic Coverage: Once you reach the catastrophic coverage phase, you pay a
much lower coinsurance or copayment for the rest of the year.
- Extra Help: Low-income individuals may qualify for Extra Help to pay for Part D
premiums, deductibles, and coinsurance.
Choosing a Part D Plan:
- Compare Plans: Plans vary in cost, coverage, and formularies. Use the Medicare Plan
Finder tool to compare plans in your area.
- Consider Your Medications: Make sure the plan covers the drugs you take and check the
plan's formulary and tier structure (which determines your cost-sharing).
- Enrollment Periods: You can enroll in a Part D plan when you first become eligible for
Medicare or during the annual Open Enrollment Period (October 15 - December 7).
Late Enrollment Penalty:
- If you don't enroll in a Part D plan when you're first eligible and don't have other
creditable drug coverage, you may have to pay a late enrollment penalty for as long as
you have Part D.
Remember: Part D is an important part of your Medicare coverage. It's crucial to choose a plan
that meets your needs and budget to ensure you have access to the medications you need.
