Medicare Part D (Prescription Drug)

Part D is a stand-alone drug plan, offered by insurers and other private companies to people who get benefits through Original Medicare, a Medicare Private Fee-for-Service Plan, a Medicare Cost Plan, or a Medicare Medical Savings Account Plan. Everyone with Medicare, regardless of income, health status, or prescription drugs used, can get prescription drug coverage.

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. It provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses. You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may pay a penalty. If you didn't join when you were first eligible, your next opportunity to join will be from November 15 to December 31 of each year.

How Medicare prescription drug coverage works

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage. Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

Who can enroll in a Medicare prescription drug plan

Anyone who has Medicare Part A, Medicare Part B or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. You can wait to enroll in a Medicare Part D plan if you have other prescription drug coverage but, if you don't have prescription coverage that is, on average, at least as good as Medicare prescription drug coverage, you will pay a penalty if you wait to join later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.

The cost of Medicare prescription drug coverage

Like other insurance, if you join a Medicare prescription drug plan, generally you will pay a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213.

How to Enroll in a Medicare prescription drug plan

Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, or enrolling online. Medicare drug plans aren't allowed to call you to enroll you in a plan.

Contact the plan to find out how you can join. When you join a Medicare drug plan, you will have to provide your Medicare number and the date your Part A or Part B coverage started. This information is on your Medicare card.  Call us to to find Part D plans in your area.

The Medicare prescription drug coverage gap (the "Doughnut Hole")

Most Medicare drug plans have a coverage gap, sometimes called the "Doughnut Hole". This means that after the person and the person's drug plan have spent a certain amount of money for covered drugs, the person then has to pay all costs out-of-pocket for the drugs, up to a limit. The yearly deductible, co-insurance or co-payments, and what the person pays while in the coverage gap all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium.

Current pending legislation may reduce or eliminate the impact of the donut hole.

For more information, or to speak directly with one of our Medicare experts, please call us at (818) 783-6030. We look forward to working with you!