What Is Medicare Part D


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What Is Medicare Part D

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Of the various parts of medicare, part d maybe the simplest and the most complex to explain and understand. First of all Medicare Part D Plans provide coverage for prescription drugs that you purchase locally or through mail order. However there is more to know about medicare part d, such as what is covered and how much will it cost.


Medicare Part D Presription Drug Plans (PDP)

First of medicare part d plans are offered by private companies approved by the government’s Centers for Medicare and Medicaid Services. These companies have a federal contract with Medicare. These private medicare part d insurance companies may offer plans with different levels of coverage, so you may want to check with a licensed advisor to determine the plan providing you with the coverage that you need.


Is a stand alone prescription drug plan right for you?

You may choose a stand-alone prescription drug plan part d if you choose to stay in Original medicare or if you select a medicare supplement policy.

When you contact our medicare coverage helpline, a licensed medicare specialist will help you compare your current prescription drug needs with the plan’s Formulary and coverage and the cost for the medications you take. Although each private insurance carrier providing medicare part d coverage must cover all the dug classes required by Medicare, that does not mean they cover every single medicine. You also should consider which pharmacies are participating in the plan you are considering enrolling into. It would also be good to consider if there are any mail delivery options provided by the medicare part d plan under consideration. Finally you should make sure the premium and your cost sharing is something you can afford. Contact our medicare coverage helpline and speak with a medicare specialist about finding an affordable medicare part d plan.


How Does Medicare Part D Cover – What Do I Pay?

The Centers for Medicare and Medicaid establish annual guidelines requiring any private insurance carrier to meet the minimum standards for Part D plan(s) offered. For 2018, there is a $405 deductible. You’ll stay in your Initial Coverage Stage until your year to date prescription drug usage reaches $3750. Once you reach $3750 of total drug costs, your level of cost sharing may suddenly change the next time you visit the pharmacy. You will definitely notice the cost difference while in the coverage gap or “donut hole” as it is often refereed to as. While in the coverage gap you must pay a higher portion of the cost of your prescriptions. For example while in the gap, you will 45% of the plans cost for covered brand name drugs and 44% of the plans cost for generic drugs. You remain in the coverage gap or donut hole until you reach a total of $5000 of out of pocket costs. After reaching $5000 of out of pocket costs you go into Catastrophic Coverage and remain there for the rest of the year. With catastrophic coverage you pay whichever amount is the greater of 5% of the cost or $3.35 co-pay for generic including brand drugs treated as generic and $8.35 co-pay for all other drugs.




Extra Help from Medicare

You may qualify for extra help with medicare prescription part d costs. This assistance is not related to Medicaid benefits and is available to persons with limited income. To apply, call your prescription part d drug plan or the Social Security office at Call 1-800-772-1213 1-800-772-1213. When the phone is answered an auto-attendant will ask you to speak the reason for your phone call. You should clearly state “Extra Help”. You will be directed to receive more information about Extra help with medicare prescription drug costs. If you qualify for extra help through Social Security, Medicare will pay for all or part of your Part D monthly premiums and you will experience lower copayments at the pharmacy.


To get help understanding your Medicare part d plan options, please contact our Medicare Coverage Helpline at Call 1-866-936-3831 1-866-936-3831

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