Medicare Part D offers prescription drug coverage.

Medicare Part D helps cover prescription costs.

What is Medicare Part D?

Medicare Part D, the prescription drug benefit, started on January 1, 2006, following the passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2003, providing the first outpatient prescription drug coverage for Medicare beneficiaries through private plans.

Who is eligible?

Medicare Part D drug coverage is available to anyone with Medicare. To join a plan, you must live in that plan’s service area and be a United States citizen or lawfully present in the United States.

Why do I need to have it?

Even if you don’t take any drugs now, consider getting Medicare drug coverage when you first sign up for Medicare. If you go 63 days or more in a row without Medicare drug coverage OR other creditable prescription drug coverage (ex. Employer group plan) after you were eligible for Medicare, you may have to pay a Part D late enrollment penalty if you sign up for Medicare drug coverage later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage.

Options for coverage

Part D is available through stand-alone Prescription Drug Plans (PDPs) or as part of a Medicare Advantage (Part C) plan.

Stand Alone Prescription Drug Plans (PDP)

These plans are separate insurance plans from private insurance companies that add drug coverage to Original Medicare (Parts A and B) or Medicare Supplement (Medigap) plans. These plans may have a monthly premium, a deductible and/or co-pay for prescriptions. Each plan has a list of covered drugs (formulary), divided into tiers which determine what you will pay for prescriptions.

Medicare Advantage Plans and Part D

If you enroll in a Medicare Advantage Plan (Part C) that includes prescription drug coverage, you do not need to enroll in a separate Part D plan. Most importantly, if you enroll in a Part D plan while enrolled in a Medicare Advantage plan with prescription drug coverage, you will be disenrolled from your Medicare Advantage plan and placed on Original Medicare Parts A and B. You can’t be enrolled in a Medicare Advantage plan with Prescription Drug Coverage and a stand-alone Part D plan.

Please contact us if you have questions about Medicare Part D before making any changes to your current plan. We are happy to answer your questions and guide you through the process.

Medicare Part D Out of Pocket Expense

Each year CMS sets the rules for Maximum Out of Pocket (MOOP) cap for the Part D program. The MOOP cap is your out-of-pocket spending including deductibles, copays and coinsurance for covered drugs. Once you hit the limit for the year, you’ll stop paying for covered drugs and your plan pays 100% for the rest of the year.

Contact us for the Maximum Out of Pocket amount for the current year.