Medicare Part D - Vista Mutual Insurance Services

Medicare Part D

Medicare Part D is prescription drug coverage for people with Medicare. Original Medicare (Part A and Part B) does not cover over-the-counter medications. Part D plans are approved by Medicare and administered by private insurance companies.

Part D plans can either be stand-alone or can come as part of your Medicare Advantage plan. However, you can only have one Part D plan. If your Medicare Advantage plan includes Part D and you enroll in a stand-alone Part D plan, you will be automatically disenrolled from your Medicare Advantage Plan.

To learn more about Part D plans, click here.

Medicare Part D plans have a few key features:

Most Part D plans have several stages. The Part D standard model has a deductible stage, then an initial coverage stage, followed by the coverage gap stage, and finally a catastrophic coverage stage. Not all plans will follow this structure. What phase you are in will depend on your specific medications.

Part D plans have a formulary (list of approved medications). Before enrolling, check to make sure your drugs are on the formulary.

Plans place drugs on different levels, called “tiers.” Medications in each tier will have a different cost. Generally, drugs on tier 1 will be less expensive than those on tier 4.

Before enrolling, it’s important to look at the plan’s premium, deductible amount, copays, and coinsurance amounts for your specific medications. Part D plans can vary significantly in these areas.

Some people qualify for special programs to help lower the cost of their medications. Contact Medicare to see if you are eligible.

Some people will pay an Income-Related Monthly Adjustment Amount (IRMA) based on their income level. Individuals who earn over a certain threshold will have to pay more for their Part D plan. Medicare determines your IRMA amount, which is the same for whatever Part D plan you choose. To learn more about IRMA, click here.

If you don’t get a Part D plan when you are first eligible, you may have to pay a late-enrollment penalty. The penalty does not apply to you if you had creditable coverage or qualify for Extra Help. The Part D penalty is equal to 1% of the average monthly cost of a Part D plan for each month that you were eligible to join but did not. The penalty will remain for as long as you have a Part D plan.

There are specific times when you can enroll in a Part D plan. Some examples include during your Initial Enrollment Period (when you first get on Medicare) and during the Annual Enrollment Period (each year from Oct 15th through Dec 7th).

What you will pay for your medications will vary greatly depending on what Part D plan you choose. Therefore, it is important to know what drugs your plan covers and what tier each medication is on. In addition, because you can only enroll in Part D at specific times and you may have a penalty if you enroll late, it is important to get a drug plan when you are first eligible.

Watch our video on Part D plans by clicking here.

We are not connected with or endorsed by the United States government or the federal Medicare program.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.