What you need to know about Medicare Part D

What is covered?

Medicare Part D, also known as a Prescription Drug Plan, offers prescription drug coverage to Medicare enrollees.  Medicare Prescription Drug Plans subsidize the costs of prescription drugs for beneficiaries, and offer drugs that may not be covered by Medicare Advantage Plans (Part C Plans).

Each Part D Plan has its own list of covered drugs called a formulary, or prescription drug list.  There are different tiers of drugs in this formulary, usually grouped by the cost of the respective drugs.  A lower tier drug generally costs less than a drug in a higher tier.  This formulary can change during the year.  If a change involves a drug you are taking at the time of the change, your Plan will provide a written notice to you at least 60 days prior to the date the change takes effect.  In addition, the Plan will provide a 60-day supply of the drug under the same rules as before the change, at the time you request a refill.

How to get Part D?

You can enroll in a Prescription Drug Plan when you first become eligible for Medicare, that is the 7-month window surrounding and including your birthday month; which is your birthday month, 3 months before it, and 3 months after it (Initial Enrollment Period).  Part D Plans can also be applied for or changed during the Medicare Open Enrollment Period lasting from October 15 to December 7 every year.  But if you enroll outside the Initial Enrollment Period, you will likely pay a late enrollment penalty, unless:

  • You have another creditable prescription drug coverage, like prescription drug coverage from your employee or union that on average covers the same amount as Medicare Part D. In these cases, you will be allowed to keep that coverage until you decide to enroll for Medicare Part D, and when you do, a late enrollment penalty does not apply.
  • You qualify for Extra Help from Medicare to pay for prescription drugs.

Some Part C Plans also offer prescription drug coverage, but you may have to enroll in Part D if Part C does not cover the drugs you require.  If you decide to enroll in a stand-alone Part D Plan, you will be automatically disenrolled from Part C.

Once you choose a Plan, you may enroll on a Plan’s provider website by completing an enrollment form.  Call e-TeleQuote at 1-855-844-0155, or Medicare at 1-800-MEDICARE for guidance.

What are the costs of Medicare Part D?

You will pay a monthly premium, an annual deductible, copayment or coinsurance, coverage gap costs, and a late enrollment penalty (if you enroll after Initial Enrollment Period) as part of your Part D Plan costs.  Your actual drug plan costs will vary depending on the drugs you use, the Plan you choose, the pharmacy you go to, and if you get Extra Help in paying your Part D costs.  Seek advice from an insurance expert at e-TeleQuote or talk to a Medicare representative to review your Plan costs and benefits, before enrolling in one.

This is not a complete description of the details of Medicare Prescription Drug Plans.  To find out more, contact an e-TeleQuote health insurance agent at www.e-telequote.com or at 1-855-844-0155.

Sources: medicare.gov

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