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What Is Medicare Part D?
Summary
What Is Medicare Part D?
Prescription drug coverage is provided under Medicare Part D. A stand-alone Medicare prescription medication plan or a Medicare Advantage prescription drug plan are available to you. Both are accessible from private insurance firms that have been approved by Medicare.
Although Medicare Part D coverage is optional, if you don’t enroll as soon as you’re eligible, you may be charged a late-enrollment penalty if you later enroll.
Your monthly plan premium and Medicare prescription drug out-of-pocket costs will differ from plan to plan.
Tip: Every year, check your Medicare Drug coverage to determine if it covers the prescriptions you need now and may require in the coming year.
medicare prescription drug plans have a formulary, which is a list of medications that are covered. The formularies differ between plans.
Be aware that your plan’s formulary may change. You should check the Annual Notice of Change that the plan gives you every fall to ensure that your prescription prescriptions will be covered in the coming year.
What else should you know about Part D Medicare prescription drug coverage?
No matter what type of medicare advantage plan you have, here are some things to keep in mind.
- Costs incurred before your deductible has been met: If your plan has an annual deductible, you will typically be responsible for the entire cost of your prescription drugs until the deductible is satisfied.
- Costs during the first year of coverage: After you’ve met your yearly deductible, you’ll be responsible for a portion of the expenditures based on your plan’s conditions. Your part could be a fixed amount (copayment) or a percentage of the overall value, which you normally pay to the pharmacy at the time of pickup (coinsurance).
- Costs in the coverage gap: In 2022, if you and your plan spend a total of $4,430 (the first coverage maximum), you’ll be moved to a new Medicare Part D coverage phase. You’ll pay no more than 25% of the cost of each covered prescription during this time. Year to year, the starting coverage limit may fluctuate.
- Costs of catastrophic coverage: You automatically acquire “catastrophic coverage” after paying a specific annual maximum amount out of pocket for eligible prescription medications. This implies you’ll just have to pay a minimal copayment or coinsurance amount for prescription medications for the rest of the year. In 2022, when you’ve spent $7,050 on Medicare Part D, you’ll be eligible for catastrophic coverage. This figure is subject to change from year to year.
Check with your doctor to verify if you’re taking the least expensive meds available. Specific coverage may differ from one plan to the next, so read your paperwork carefully.
Who’s eligible for a Medicare Part D prescription drug coverage?
A stand-alone Medicare Part D prescription medication plan is available to any beneficiary who is eligible for Original Medicare, Part A, and/or Part B. You must have both Part A and Part B if you want to enroll in a medicare advantage plans that cover the prescription drug.
You must live inside the plan’s coverage region in either case.
Only a specific initial enrollment period allows you to enroll in either type of Medicare prescription medication coverage.
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