When you first start learning about Medicare, one of the most confusing parts can be figuring out how your prescriptions are covered. That’s where Medicare Part D comes in.
Part D is Medicare’s prescription drug program. It helps cover the cost of medications you take regularly, whether that’s something for high blood pressure, diabetes, or just an occasional antibiotic. It’s not included with Original Medicare, so if you want prescription coverage, you’ll need to add it separately.
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Whether you need Medicare Part D depends largely on your current and future prescription drug needs. Here’s a fresh look at when it might make sense.
You may benefit from enrolling in Part D
If you take any medications, or even if you don’t right now, it’s a good idea to have drug coverage in place. Without it, you could end up paying the full cost of prescriptions out of pocket, and you might also face a late enrollment penalty down the road if you decide to join later.
Even healthy individuals are encouraged to enroll when they’re first eligible. There It’s not just about what you need today, it’s about protecting yourself in case things change.
If you rely on prescriptions, or simply want to protect yourself from future expenses and penalties, Part D is worth considering even if you’re not taking medications today.
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Every Medicare Part D plan is offered by a private insurance company that contracts with Medicare. You’ll choose a plan that’s available in your area, and each plan will have its own monthly premium and cost structure.
Most plans have a few basic parts:
As you use the plan throughout the year, your out-of-pocket costs go through different phases. One of these is often called the “donut hole,” where your costs may be temporarily higher. But there are limits on how much you’ll pay, and once you reach a certain threshold, you enter what’s called catastrophic coverage, where your costs drop again.
You don’t have to memorize all the terms, we’re here to help you understand what it means for your personal situation.
There are two main ways to get prescription drug coverage through Medicare.
If you have Original Medicare (Parts A and B), you can sign up for a standalone Part D plan. This plan will only cover your medications and works alongside your other Medicare coverage.
If you have a Medicare Advantage plan (Part C), many of those already include drug coverage. These plans are often called MAPD plans. If you’re considering Medicare Advantage, it’s important to check whether your prescriptions are covered and what the out-of-pocket costs will be.
We know it can be confusing, and there are pros and cons to the various options. If you need help and want to get more information, our services are completely free of charge to you. Give us a call to go over your options and explore which plan is best for your needs.
Not all Part D plans are the same. Even though they all follow Medicare rules, they may cover different drugs, work with different pharmacies, or have different costs.
When we help people compare plans, we look at things like:
It’s not always about picking the lowest premium, sometimes a plan with a slightly higher monthly cost ends up saving you more overall.
Most people sign up for Part D during their Initial Enrollment Period, which starts three months before you turn 65 and lasts for seven months total.
If you don’t enroll when you’re first eligible and you don’t have other creditable drug coverage (like through an employer), you might have to wait until the Annual Enrollment Period, which runs from October 15th to December 7th each year.
There are also Special Enrollment Periods that apply if you lose other coverage or move to a new area. We can help you figure out whether any of these apply to you.
There are a few things we see often that can lead to frustration, or even costly gaps in coverage.
One is waiting too long to enroll. Many people don’t realize that if they skip drug coverage when they’re first eligible, they may have to pay a penalty later.
Another is choosing a plan based only on the monthly premium. A plan might look inexpensive upfront but end up costing more if it doesn’t cover your medications well or requires higher copays.
And finally, it’s easy to assume all plans cover the same drugs but they don’t. That’s why it’s so important to check each plan’s formulary (the list of drugs they cover) before enrolling.
Choosing a Medicare Part D plan can feel overwhelming, but you don’t have to do it alone. Our licensed advisors are here to help you compare your options, understand your costs, and enroll in a plan that works for you.
There’s no cost for our help, and no pressure to make a decision before you’re ready. We’re simply here to provide the support and answers you need.
