Here Are the Facts on Medicare Part D

Medicare Part D

Medicare Part D is Medicare’s standard prescriptions drug coverage, and is, like Part C, furnished by private insurance companies, not directly by Medicare. Though it is not absolutely necessary for any Medicare participants to enroll in Medicare Part D, as it is not required, it ensures access to the medications and prescriptions that are essential to maintaining your health. Of course, you could skip Part D and pay for your prescriptions out of pocket, but this is prohibitively expensive for most people.

How to Enroll in Medicare Part D

Though you do not have to enroll in Part D when you first start with Medicare-you are neither automatically nor required to participate in Part D-if you do not sign up when you are first eligible for the plan, you may end up paying an enrollment fee later when you do decide to opt in. If you are enrolling in Original Medicare (Parts A and B), you can sign up for Part D at the same time. Many Medicare Advantage (Part C) plans automatically include a Part D section, as prescription drug coverage is often a standard part of traditional insurance plans.

What Medicare Part D Covers

Every Part D plan is different, but all have the same standard components. Drugs are separated into “tiers” based on how they are formulated. As you progress from a lower tier to a higher tier of formulation, the cost of the drug will also increase. This strikes a clear line in between the price for generic prescriptions and brand name prescriptions. If there are similar drugs are two disparate tiers, and your doctor requires you to take the drug from the higher tier, you can request a lower copayment from your insurance company.

In general, all medically necessary drugs are covered by Part D. Because doctors will rarely prescribe a drug to their patients that do not have either health maintaining or health bettering effects, Part D is fairly liberal drug coverage.

Costs for Part D

Premiums for prescription drug coverage are based on your adjusted gross income, as reported to the IRS. These costs are in addition to the costs for your standard Medicare Part A and B plans, but if you cannot afford these rates, Medicare has a contingency plan in place to ensure even those with extremely income can still receive the medications they desperately need.

Drug plans operate either with copayments or coinsurance. With copayments, every tier of drugs has a standard cost. With coinsurance, each tier has a standard percentage of the original drug price.

Part D in Conjunction with Other Insurance

Though Part D is open to all, there are many insurance programs that already include prescription drug coverage and might be negated entirely if you enroll in Part D. Part C Advantage Plans incorporate the coverage of Part D in to their services. Most other standard insurance plans have prescription drug coverage, including Medicaid, COBRA, and benefits from unions or past employers. Before enrolling in Part D, make sure that your drug costs are not already covered by another plan.