Medicare Part D Explained

Medicare Part D prescription coverage comes with lots of rules and regulations. Our office in Springfield, MO has been helping people find and Part D plans available in Missouri for over 16 years! We’ll break down your main questions and concerns in this article.

Original Medicare comes in three parts:

  • Part A, which is premium-free and covers hospital fees;
  • Part B, which has a set premium and covers doctors visits and medical equipment; and
  • Part D prescription coverage, which has a premium based on the plan you choose. Part D plans are only offered by private companies.

Enrollees can choose a Medigap (also known as a Medicare Supplement) plan to help with copays and coinsurance if they choose Original Medicare.

Instead of relying on Medigap to cover out-of-pocket expenses, enrollees can also choose a Medicare Advantage plan. These are private plans that offer different coverages, with some offering Part D prescription coverage.

When am I Eligible for Medicare Part D?

You can usually sign up for Part D when you sign up for Part A and Part B. This includes when you turn 65 (and meet a few other qualifications), if you have a disability and are enrolling in Medicare, if you have End-Stage-Renal-Disease, and a few other uncommon situations.

Getting Part D Prescription Drug Coverage

Part D coverage is separate from Part A and Part B. The first way to get Part D is to enroll in a standalone Part D plan. The second way is to enroll in a Medicare Advantage (Part C) plan, which is a plan offered by private insurers. Only some Medicare Advantage plans have prescription drug coverage included, so you’ll want to ask specifically about this.

Medicare Part D Late Enrollment Fee

The Medicare system wants you to have continuous Part D coverage. They impose a fee if you go without Part D coverage for more than 63 days in a row unless you have credible coverage. This includes not signing up for Part D when you’re first eligible. This fee will last for the rest of your life, so be sure to get Part D coverage when you become eligible.

Shows a pack of pills with the text: Reminder, if you don't sign up for Part D Coverage when you're eligible, you may have to pay a fee for the rest of your life.

Dealing with Part D Formularies and Tiers

A formulary is a list of drugs that a plan covers. Each plan is required to cover 2 drugs from every popular category. If your doctor prescribes a drug that’s not on the list, and there are no alternatives that will work, you can request an exception.

Each plan also divides drugs into tiers in a different way. The lower tiers have a lower copay and usually include generic drugs. If your doctor doesn’t think any of the drugs in a lower tier will work for you, you can request an exception here too. An exception may allow you to pay less for a drug that’s in a higher tier.

Which Part D plans cover my prescription drugs in 2020?

Each plan is different and may even change throughout your coverage period. The best way to find a Medicare Part D Plan in 2020 that covers your drugs (and doctors for that matter) is to use the online tool at the top of our homepage or come in for a no-cost visit to choose your insurance. We can look up each of your drugs to be sure we find a plan that will be the right fit.

How much will Part D Prescription Drug Coverage Cost?

Your Part D costs are determined by the plan you choose. In addition, if you make over a certain amount each year, you’ll have an additional fee based on your income. See this article for more information on Medicare Part D costs.

What is the Part D Donut Hole (Coverage Gap)?

The donut hole, or coverage gap, are commonly used terms in our industry, and even among Medicare enrollees. But if you’re new to Medicare, you may be wondering what they mean. 

Prescription drug plans cover your prescriptions up to a certain amount- $4020 in 2020. This $4020 includes both their coverage, and any copays or deductibles you pay. After you reach $4020, your prices will usually go up to about 25%, depending on your plan. As costs accumulate during the coverage gap, you’ll move into “Catastrophic Coverage” once you meet an even higher threshold. Your costs while in Catastrophic Coverage will be reduced again.

For a more in-depth description and a handy infographic that helps explain it, visit our article on Part D Costs.

Can I Get Help Paying for Part D Costs?

Medicare offers a program called Extra Help for those who fall below a certain income threshold. If you qualify, you will pay a small percentage of normal prescription costs. Our Help Paying for Medicare article goes into more detail on different programs that can help you afford your premiums, deductibles, copays, and coinsurance.

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At 417 Insurance and Investments, we understand that the many options for Part D plans can be confusing. We’ve helped hundreds of seniors and other Medicare enrollees choose the plans that are right for them based on both their current prescription needs and future healthcare considerations. Our help has no cost for you- come see us to get a Medicare insurance agent on your side.

Fill Out Your Basic Info to See Your Medicare Plan Options

Adam works with Medicare clients to answer questions, assist with enrollment, and run plan comparisons to find the right one for your needs.

He’s also an expert in Dual Enrollment for those on both Medicare and Medicaid.

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