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Medicare D

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Medicare D

Medicare D is a prescription drug benefit program that is offered as part of the broader Medicare federal health insurance program for persons 65 years and older, certain younger people with disabilities, and people with end-stage renal disease. It is an optional benefit that is administered by private insurance companies and available to anyone who has Medicare.

What is Medicare D (Prescription Drug Benefit)?

Medicare D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage prescription drug plan (MA-PD), mainly HMOs and PPOs, that cover all Medicare benefits including drugs. In 2020, 46 million of the more than 60 million people covered by Medicare are enrolled in Part D plans.

How does Medicare D work?

Medicare offers two ways to get prescription drug coverage—Medicare D and Medicare Advantage. Medicare D is one component of the overall Medicare program, which is a national health insurance program.

While Medicare extends to a wide variety of medical treatments, Medicare D is focused specifically on making drug prices more affordable for Americans 65 years and older.

People already covered by Medicare generally can opt in to Medicare D. If you do, you will be charged the same kinds of costs found with standard insurance plans, such as monthly premiums, annual deductibles, and various copays. In exchange, you get additional coverage for prescription drugs as compared to what is already offered by the broader Medicare program. For this reason, it’s up to you to choose whether subscribing to Medicare D makes economic sense, given your health needs and financial circumstances.

How much does Medicare D cost?

You’ll make these payments throughout the year in a Medicare drug plan:

Premium
Yearly deductible
Copayments or coinsurance
Costs in the coverage gap
Costs if you get Extra Help
Costs if you pay a late enrollment penalty

Your actual drug coverage costs will vary depending on:

Your prescriptions and whether they’re on your plan’s list of covered drugs (formulary).

What “tier” the drug is in.
Which drug benefit phase you’re in (like whether you’ve met your deductible or if you’re in the catastrophic coverage phase).
Which pharmacy you use (whether it offers preferred or standard cost-sharing, is out of network, or is mail order). Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less.
Whether you get extra help paying your drug coverage costs.

Already have Medicare D ? Switching is easy

It might be time to switch insurers whenever the service that your existing insurer provides doesn’t meet your needs. For example, if you have a poor claims experience or an unexplained rate increase, it might be time to consider other options

If you cancel a previous policy before a new policy is effective, you could run into some serious financial problems.

Contact us today to help you with multiple options to choose from.

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