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Call Us Today! (866) 639-1662
Medicare Part D prescription drug coverage typically covers medications you have filled at a pharmacy (as opposed to medications you have administered at a doctor’s office or hospital – which usually fall under Part B). There are only two ways to get Part D coverage: by purchasing a standalone prescription drug plan or by enrolling into a Medicare Advantage plan that includes Part D coverage. To be eligible for a standalone prescription drug plan you must first have Medicare Part A and/or Part B and live in the plans service area. To be eligible for a Medicare Advantage plan with Part D coverage you must have both Medicare Parts A and B and live in the plans service area.
What costs are associated with Part D?
Part D premiums
Most drug plans charge a premium which varies from plan to plan. Your Part D plan premium is in addition to your Part B premium. If you are enrolled in a Medicare Advantage plan (e.g.: an HMO or PPO) the premium for your plan may include your Part D premium.
Part D deductibles
A deductible is the amount you have to pay before a plan will cover a medication. Some prescription drug plans have a deductible, other plans do not. Plans may have deductibles for brand name drugs while generic drugs may not be subject to a deductible.
Drug co-pays or coinsurance
A co-pay or coinsurance is the amount you pay for medications after your deductible is met (if your plan has a deductible), this is typically called the “Initial Coverage” phase. Drugs are grouped into cost sharing “Tiers” with corresponding co-pays or co-insurance. Generally, the lower the drug tier, the lower the co-pay.
For example, Tier 1 drugs are typically preferred generics and will have the lowest co-pays. Tier 2 drugs are usually non-preferred generics and will have a higher co-pay then Tier 1. Tier 3 are generally categorized as preferred brand drugs with a higher copy than Tier 2, and Tier 4 drugs are usually non-preferred drugs with an even higher co-pay. Many drug plans will also list Tier 5 as specialty drugs (such as injectables) which you may be responsible for a percentage of the full cost (known as a “coinsurance”).
Donut Hole/Coverage Gap
The Coverage Gap (a.k.a. “The Donut Hole”) is the phase you could reach if the full cost of your medications (meaning your co-pay or coinsurance plus what your drug plan pays) reaches a certain amount. This amount may change from year to year. Once you are in the Coverage Gap you are then responsible for 25% of the full cost for brand name and generics drugs. Note: people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Example: If you are taking a preferred brand drug that has a full cost of $200, your preferred brand co-pay might be $50 (before you hit the coverage gap) which would make your drug plan’s portion $150. If you were to hit the Coverage Gap during the year, your cost for that brand drug would then be 25% of $200 (the full cost of the drug) which equals $50.
Catastrophic Coverage
The catastrophic phase occurs when your total expenses for your medications during the deductible phase, the Initial Coverage phase and the Coverage Gap phase has reached a certain amount. It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
Do I have to have Part D coverage?
The short answer is no. But if you decide not to enroll in a Part D plan when you are first eligible and you do not have other creditable drug coverage (like from an employer or union plan) or receive a Low Income Subsidy, you may end up having to pay a Part D Late Enrollment Penalty (LEP). Medicare calculates the amount of your Part D LEP by 1% of the national average premium (also called the "national base beneficiary premium") times the number of months you didn’t have Part D or creditable drug coverage.
Things to consider
Before choosing a drug plan, it is important to determine not only if the medications you are taking are covered by the plan you are considering, but also what tier your medications may fall under and whether or not you will reach the drug coverage gap. These factors will have a direct impact on what you will be paying for your medications throughout the year.
Click here to get a free quote for Part D prescription drug plans in your area, or call us direct at: (866) 639-1662
Medicare Part D prescription drug coverage typically covers medications you have filled at a pharmacy (as opposed to medications you have administered at a doctor’s office or hospital – which usually fall under Part B). There are only two ways to get Part D coverage: by purchasing a standalone prescription drug plan or by enrolling into a Medicare Advantage plan that includes Part D coverage. To be eligible for a standalone prescription drug plan you must first have Medicare Part A and/or Part B and live in the plans service area. To be eligible for a Medicare Advantage plan with Part D coverage you must have both Medicare Parts A and B and live in the plans service area.
What costs are associated with Part D?
Part D premiums
Most drug plans charge a premium which varies from plan to plan. Your Part D plan premium is in addition to your Part B premium. If you are enrolled in a Medicare Advantage plan (e.g.: an HMO or PPO) the premium for your plan may include your Part D premium.
Part D deductibles
A deductible is the amount you have to pay before a plan will cover a medication. Some prescription drug plans have a deductible, other plans do not. Plans may have deductibles for brand name drugs while generic drugs may not be subject to a deductible.
Drug co-pays or coinsurance
A co-pay or coinsurance is the amount you pay for medications after your deductible is met (if your plan has a deductible), this is typically called the “Initial Coverage” phase. Drugs are grouped into cost sharing “Tiers” with corresponding co-pays or co-insurance. Generally, the lower the drug tier, the lower the co-pay.
For example, Tier 1 drugs are typically preferred generics and will have the lowest co-pays. Tier 2 drugs are usually non-preferred generics and will have a higher co-pay then Tier 1. Tier 3 are generally categorized as preferred brand drugs with a higher copy than Tier 2, and Tier 4 drugs are usually non-preferred drugs with an even higher co-pay. Many drug plans will also list Tier 5 as specialty drugs (such as injectables) which you may be responsible for a percentage of the full cost (known as a “coinsurance”).
Donut Hole/Coverage Gap
The Coverage Gap (a.k.a. “The Donut Hole”) is the phase you could reach if the full cost of your medications (meaning your co-pay or coinsurance plus what your drug plan pays) reaches a certain amount. This amount may change from year to year. Once you are in the Coverage Gap you are then responsible for 25% of the full cost for brand name and generics drugs. Note: people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Example: If you are taking a preferred brand drug that has a full cost of $200, your preferred brand co-pay might be $50 (before you hit the coverage gap) which would make your drug plan’s portion $150. If you were to hit the Coverage Gap during the year, your cost for that brand drug would then be 25% of $200 (the full cost of the drug) which equals $50.
Catastrophic Coverage
The catastrophic phase occurs when your total expenses for your medications during the deductible phase, the Initial Coverage phase and the Coverage Gap phase has reached a certain amount. It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
Do I have to have Part D coverage?
The short answer is no. But if you decide not to enroll in a Part D plan when you are first eligible and you do not have other creditable drug coverage (like from an employer or union plan) or receive a Low Income Subsidy, you may end up having to pay a Part D Late Enrollment Penalty (LEP). Medicare calculates the amount of your Part D LEP by 1% of the national average premium (also called the "national base beneficiary premium") times the number of months you didn’t have Part D or creditable drug coverage.
Things to consider
Before choosing a drug plan, it is important to determine not only if the medications you are taking are covered by the plan you are considering, but also what tier your medications may fall under and whether or not you will reach the drug coverage gap. These factors will have a direct impact on what you will be paying for your medications throughout the year.
Tap here to get a free quote for Part D prescription drug plans in your area, or call us direct at: (866) 639-1662
Medicare Part D prescription drug coverage typically covers medications you have filled at a pharmacy (as opposed to medications you have administered at a doctor’s office or hospital – which usually fall under Part B). There are only two ways to get Part D coverage: by purchasing a standalone prescription drug plan or by enrolling into a Medicare Advantage plan that includes Part D coverage. To be eligible for a standalone prescription drug plan you must first have Medicare Part A and/or Part B and live in the plans service area. To be eligible for a Medicare Advantage plan with Part D coverage you must have both Medicare Parts A and B and live in the plans service area.
What costs are associated with Medicare Part D?
Part D premiums
Most drug plans charge a premium which varies from plan to plan. Your Part D plan premium is in addition to your Part B premium. If you are enrolled in a Medicare Advantage plan (e.g.: an HMO or PPO) the premium for your plan may include your Part D premium.
Part D deductibles
A deductible is the amount you have to pay before a plan will cover a medication. Some prescription drug plans have a deductible, other plans do not. Plans may have deductibles for brand name drugs while generic drugs may not be subject to a deductible.
Drug co-pays or coinsurance
A co-pay or coinsurance is the amount you pay for medications after your deductible is met (if your plan has a deductible), this is typically called the “Initial Coverage” phase. Drugs are grouped into cost sharing “Tiers” with corresponding co-pays or co-insurance. Generally, the lower the drug tier, the lower the co-pay.
For example, Tier 1 drugs are typically preferred generics and will have the lowest co-pays. Tier 2 drugs are usually non-preferred generics and will have a higher co-pay then Tier 1. Tier 3 are generally categorized as preferred brand drugs with a higher copy than Tier 2, and Tier 4 drugs are usually non-preferred drugs with an even higher co-pay. Many drug plans will also list Tier 5 as specialty drugs (such as injectables) which you may be responsible for a percentage of the full cost (known as a “coinsurance”).
Donut Hole/Coverage Gap
The Coverage Gap (a.k.a. “The Donut Hole”) is the phase you could reach if the full cost of your medications (meaning your co-pay or coinsurance plus what your drug plan pays) reaches a certain amount. This amount may change from year to year. Once you are in the Coverage Gap you are then responsible for 25% of the full cost for brand name and generics drugs. Note: people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Example: If you are taking a preferred brand drug that has a full cost of $200, your preferred brand co-pay might be $50 (before you hit the coverage gap) which would make your drug plan’s portion $150. If you were to hit the Coverage Gap during the year, your cost for that brand drug would then be 25% of $200 (the full cost of the drug) which equals $50.
Catastrophic Coverage
The catastrophic phase occurs when your total expenses for your medications during the deductible phase, the Initial Coverage phase and the Coverage Gap phase has reached a certain amount. It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
Do I have to have Part D coverage?
The short answer is no. But if you decide not to enroll in a Part D plan when you are first eligible and you do not have other creditable drug coverage (like from an employer or union plan) or receive a Low Income Subsidy, you may end up having to pay a Part D Late Enrollment Penalty (LEP). Medicare calculates the amount of your Part D LEP by 1% of the national average premium (also called the "national base beneficiary premium") times the number of months you didn’t have Part D or creditable drug coverage.
Things to consider
Before choosing a drug plan, it is important to determine not only if the medications you are taking are covered by the plan you are considering, but also what tier your medications may fall under and whether or not you will reach the drug coverage gap. These factors will have a direct impact on what you will be paying for your medications throughout the year.
Tap here to get a free quote for Part D prescription drug plans in your area, or call us direct at: (866) 639-1662
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. Alderetteinsurance.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-866-639-1662 to determine eligibility and to request a copy of the applicable policy. Alderetteinsurance.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every Medicare plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. Alderetteinsurance.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-866-639-1662 to determine eligibility and to request a copy of the applicable policy. Alderetteinsurance.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. Alderetteinsurance.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-866-639-1662 to determine eligibility and to request a copy of the applicable policy. Alderetteinsurance.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.