Medicare Part D

Summary:

  • Medicare Part D is for prescription drug coverage. You can enroll separately or combine it with Original Medicare (Part A and Part B). You can also enroll in Part C, Medicare Advantage, which combines Parts A, B and D.
  • If you qualify for Original Medicare, then you qualify for Medicare Part D.
  • Medicare Part D has coverage based on different tiers to fit your prescription needs.
  • You can enroll in Medicare Part D through Retirement Health Planners, another insurance group, or the government.

What's Medicare Part D?

Medicare Part D is insurance for your prescription medications. You can add Part D to your Medicare Parts A and B, or you can enroll in a Medicare Advantage plan which includes A, B, and D. You will pay a monthly premium to an insurance carrier of your choice. Then you will have access to their network of pharmacies. With Part D you won’t pay full price for prescriptions, you’ll pay a percentage of the cost or a copay.

There are multiple private plans through Medicare Part D that cover a variety of prescription drugs, even those for conditions such as cancer.

What does Medicare Part D Cover?

There are multiple private plans through Medicare Part D that cover a variety of prescription drugs, even those for conditions such as cancer. Each plan will have formularies and tiers. A formulary is a list of covered drugs. A tier is when the plans place drugs on different levels, or different costs. The higher the tier, generally the higher the cost.

Prescription Drugs

Examples of things covered by Medicare Part D

Medicare Part D covers most categories with at least two different medications. Part D usually covers vaccines, and it also covers almost all prescriptions in six categories:

  • Antipsychotics
  • Antidepressants
  • Anticonvulsants
  • Cancer Drugs
  • HIV/AIDS drugs
  • Immunosuppressants

If your doctor or insurance company do not think a medication is medically necessary, then Medicare Part D won't cover it. Examples would be: fertility drugs, erectile dysfunction medications, weight loss pills, or hair growth serums.

What do I do if I'm unsure Medicare Part D will cover what I need?

If you’re prescription medication is not covered under your plan you can pay out of pocket, request an exception, or file an appeal. All plans include at least two drugs that treat the same symptoms or have similar effects on the body.

What does it cost?

Monthly premiums for Part D vary by plan, and enrollees who make more may pay more. These private carrier plans have five tiers offering a variety of copays, generic drugs or brand name drugs, and areas of availability. If you don’t enroll initially, there will be a late enrollment penalty, which you could pay as long as you have Medicare drug coverage.

If your filing status and yearly income in 2020 was
Filed individual tax return Filed joint tax return Filed married & separate tax return You pay each month (in 2022)
$91,000 or less $182,000 or less $91,000 or less your plan premium
$91,001 to $114,000 $182,001 to $228,000 not applicable $12.40 + your plan premium
$114,001 to $142,000 $228,001 to $284,000 not applicable $32.10 + your plan premium
$142,001 to $170,000 $284,001 to $340,000 not applicable $51.70 + your plan premium
$170,001 to $499,999 $340,001 to $749,999 $91,001 to $408,999 $71.30 + your plan premium
$500,000 or above $750,000 or above $409,000 or above $77.90 + your plan premium

Who is eligible for Medicare Part D?

If you are entitled to Medicare Part A or Part B, then you are eligible for Medicare Part D. If you use prescription medications or believe you might in the future, and want to avoid a late enrollment penalty, you should consider enrolling in Medicare Part D.

If you are entitled to Medicare Part A or Part B, then you are eligible for Medicare Part D.

How do I enroll in Medicare Part D?

If you're new to Medicare, first you have to sign up for Original Medicare, and then you can enroll in Part D during initial enrollment, or during open enrollment (October 15 - December 7). Since Part D is not done by Social Security, you'll sign up through a private carrier. This can be done through speaking to one of our Independent Sales Representative.

You can also get Part D with a Medicare Advantage plan. As a reminder, you must live in the plan's coverage area, and you'll want to make sure the plan covers medications you need.

Special Enrollment

There are a few occasions in which you will qualify for a Special Enrollment:

  • You move to another plan's service area
  • Your current drug coverage ends
  • Your plan terms its contract with Medicare
  • You move to a nursing home, or leave one
  • You qualify for more help

Late Enrollment

In order to encourage everyone to sign up for Part D, there is a late enrollment penalty that will last for the life of the plan. If you go 63 days or more without drug coverage after your initial enrollment period, then the late enrollment penalty applies. To calculate the penalty:

(Number of months without coverage x 1%) x $33 (projected average Part D Premium) = Penalty

EX: You go 16 months without coverage. (16 x 1%) x $33 = $5.28. The penalty rounds to the nearest 10 cents, so you'd pay $5.30 in penalty per month for the life of the coverage.

Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance.  A licensed agent/producer may contact you.  Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.  MasterCare LLC and Insuractive LLC are licensed and certified representatives of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans they represent do not discriminate on the basis of race, color, national origin, age, disability, or sex.  For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov

Recommended Reading

Medicare Part A

Medicare Part A is a portion of Original Medicare that is often times referred to as "Hospital Insurance".

Medicare Part B

Medicare Part B is the portion of Original Medicare that is often times referred to as "Medical Insurance".

Medicare Supplement

Medicare Supplement insurance (also known as Medigap) is helps supplement some of the healthcare costs not covered by Original Medicare (Part A and B).