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Medicare Part D is coverage for outpatient prescriptions. Anyone with Medicare can elect to enroll in a Part D plan. All plans must cover many drugs commonly prescribed to people on Medicare.
Let’s look at some important things you need to know before choosing a Part D plan.
Two Ways to Get Part D
Part D plans are administered by private health insurance companies that have a contract with Medicare. Medicare does not offer Part D.
Stand-Alone Part D Plan
People with Medicare may choose to enroll in a stand-alone Part D plan. A stand-alone Part D plan is a prescription drug plan independent of the member’s health plan. In this example, the member may have either Original Medicare (Medicare A and B), specific Medical Savings Account plans, some Cost plans, or certain Private-Fee-For-Service plans.
Medicare Advantage Plan + Part D (MAPD)
Another option for enrolling in Part D is to enroll in a Medicare Advantage plan that includes Part D. Not all Medicare Advantage plans include Part D, so make sure you know what you are getting when you enroll.
To learn more about Medicare Advantage plans, click here.
Part D Penalty
Although Part D is optional, there may be a penalty if the member does not enroll in Medicare when they are first eligible. The late enrollment penalty is permanently added to the cost of your Part D plan premium. The late enrollment penalty amount will depend on how long the member was eligible to have Part D but didn’t.
Working with an experienced agent can help ensure that you are informed about when you need to enroll in Part D. You can speak to someone about your situation by clicking here.
Formulary
Although all Part D plans are required to cover certain medications, each plan varies widely in terms of the cost for each prescription. Each plan has a formulary, or list of covered drugs. It’s essential to check your plan’s formulary to make sure your medications are covered.
In the formulary, medications are grouped into tiers. Generally (although not always), drugs on higher tiers will be more expensive than drugs on lower tiers. In addition, with some Part D plans, certain tiers will require that you meet a deductible before the plan pays anything for the drug.
For many people with Medicare, having a drug plan that covers their medications at an affordable cost is extremely important. Make sure you understand when and how to enroll in Part D and what is covered by the Part D plan you select.
If you need assistance choosing a plan, call one of our experienced agents today at (800) 398-8714.
Christina Valenzuela
Christina Valenzuela is the co-owner of Vista Mutual Insurance Services, an insurance agency that focuses exclusively on the needs of Medicare beneficiaries. She has worked in the Medicare insurance industry since 2006 and is a licensed insurance producer in multiple states.
Although we strive to be as accurate as possible, any differences between this document and the information on Medicare.gov will be governed by the information on Medicare.gov.
