What Is Medicare Part D and Do I Need It?

CA Medicare Announcement

Medicare Part D is a federal-government program introduced in 2003 to help eligible Medicare recipients get subsidized prescription drug coverage. The plans are sold through private insurance companies (approved by Medicare) and often have an additional premium. There are two ways to get drug coverage—as a standalone plan coupled with Original Medicare (Parts A and B), or as part of a Part C Medicare Advantage (MA) plan.

Medicare supplement

What Do Drug Plans Cover?

Each plan has its own list of covered drugs, called a formulary. It’s important to review your plan options carefully to ensure the plan you choose covers the drugs you take. Drugs are categorized in tiers—those in lower tiers are generally less expensive than those in higher tiers. Drug plans can change their formularies during the year, but only within Medicare’s guidelines. Drug plans must provide you with written notice at least 60 days prior to the effective date of the change, and they must provide you with written notice of the change at the time you request a refill, along with a 60-day supply of the drug under the same plan rules (price, etc.) as before the change.

Where Can I Purchase a Plan?

CA Medicare offers enrollment assistance and can provide you with a custom report matching your specific drugs to the formularies of Medicare-approved drug plan carriers. We’ll work with you select the plan that best meets your needs and budget. Note that if you are in a Medicare Advantage plan, enrolling in a Part D prescription drug plan will automatically disenroll you from your MA plan and automatically enroll you in Original Medicare (Parts A and B). You can leave your MA plan and switch to Original Medicare between January 1st and February 14th of 2015.

When Can I Join a Plan?

You can purchase a standalone prescription drug plan during the 7-month period that begins three months before your 65th birthday, includes your birthday month, and includes the three months following your 65th birthday. If you join during the three-month period before you turn 65, your coverage will become effective on your 65th birthday. If you don’t join a plan during this 7-month window, you can join during the next open enrollment (as long as you are 65 or older), which takes place each year from October 15th through December 7th.

What Are the Costs for a Drug Plan?

You’ll pay a monthly premium for your drug plan, which can range from as little as $15/month to as much as $100 or more per month. You’ll also pay an annual deductible, copayment, or coinsurance amounts, and additional costs when you’re in the coverage gap, or “donut hole.” These costs vary based on the drugs you need.

Medicare Advantage Plans: An Alternate Way to Get Prescription Drug Coverage

MA plans are an alternative way to get prescription drug coverage. MA plans become primary to Original Medicare (Parts A and B), and many include prescription drug coverage. If you choose an MA plan with prescription drug coverage as an alternative to Original Medicare, you cannot enroll in a Part D plan.

Get Help Choosing a Plan

For help and information choosing the right prescription drug plan, contact the experts at CA Medicare today.