Part D Prescription Drug Coverage

Who is Eligible for Part D Coverage?

Part D, Medicare Prescription Drug Coverage is available to anyone who signs up for either Part A or Part B of Original Medicare. It's best to add Part D coverage during your 7-month Initial Enrollment Period unless you have prescriptions drug coverage through a previous retiree drug plan. Some Part C Plans include Part D coverage. These are known as MA-PD Plans. You must have Original Medicare Part A AND Part B to sign up for Part C plans. Advantage Plans without prescription drug coverage can be used with Part D policies.

How Much Will I Pay for Part D?

Part D premiums are determined by modified gross adjusted income. A small percentage of people will be charged higher rates for Part D. The current premium base rate is $32.34. Deductibles and co-payments are also part of these plans. Costs for coverage may change every year. Most Medicare Part D coverage also has a Coverage Gap. The Gap, or "donut hole," refers to a temporary gap in coverage when a patient's out of pocket expenses total more than $2840. At this time there is a halt on insurance payments until $4550 for the year is reached. Once this happens the insurance company will pay all of the costs except for a small co-pay. During the Gap the patient pays a 50% reduced rate for prescription drugs. Using generics qualifies for an additional 7% savings.

Drugs Covered By Part D?

Every Part D Plan has a separate list of drugs included in their Formulary. The Formulary is usually tiered, providing more coverage for cheaper drugs and less for more expensive drugs. Part D plans must cover all commercially available vaccines not covered by Medicare Part B.

Auntie Lou says, "I'm not sure what is more complicated, Medicare or my company's Formulary."

Extra Help is available for the cost of Part D coverage. State, private charitable organizations and prescription drug companies also often provide extra help. For Extra Help contact Medicare at 1-800-MEDICARE and TTY users call 1-877-486-2048.