What is Part D?

Medicare Part D is a prescription drug coverage program offered by private insurance companies approved by Medicare. It is designed to help Medicare beneficiaries afford the cost of prescription medications. Medicare Part D plans are available either as standalone plans, where prescription drug coverage is separate from other Medicare benefits, or as part of a Medicare Advantage plan that includes both healthcare and prescription drug coverage.

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To enroll in a Medicare Part D plan, you must be eligible for Medicare and actively enrolled in either Medicare Part A or Part B. Part D plans have a monthly premium that you pay in addition to any premium you may have for your Medicare Part B coverage.

Each Part D plan has its own list of covered medications, known as a formulary. It’s important to review a plan’s formulary to ensure the medications you need are covered. Part D plans may also have different copayments, deductibles, and coverage stages that determine how much you pay for your medications at different points throughout the year.

How to Add or Change Part D Plans

Here’s an overview of what is needed to either add Part D Medicare, you would need to make sure you have an election period, be enrolled in Medicare Part A and/or Part B, and reside in the plan service area.

Typically, you should add Part D during your Initial enrollment period for Medicare, which is the same as the enrollment period for Medicare Parts A and B, which starts three months before turning 65 and ends three months after. However, there are also other enrollment periods such as the annual election period, between October 15th to December 7th.

Another option to add Part D is using a special enrollment period – please call our office or check out Medicare.gov to learn more about special enrollment periods.

Let Us Help You with Your Part D Enrollment

Our office can help research and compare plans or direct you to Medicare’s website to compare the costs, coverage, and specific drugs covered by each plan. We help you understand all the factors such as monthly premiums, deductible, copayments, and which pharmacies are in-network.

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Common Part D Questions

Part D is a voluntary program, however it’s important to note that there may be a penalty if you delay enrolling in Part D when you are first eligible, and later choose to enroll. This penalty is added to your monthly premium and can vary depending on the length of time you were eligible but did not enroll in a Part D plan.

The important thing is to have “credible coverage” once you are past your Initial Enrollment Period (IEP) in order to not have a late enrollment penalty associated with your Part D coverage.

It’s important to note that creditable coverage is determined by the plan sponsor or employer providing the coverage. They should provide you with a notice each year indicating whether your coverage is creditable or not. If you’re unsure about the credibility of your current coverage, it’s recommended to contact your employer or health plan provider for clarification.

Creditable coverage means that the coverage provided by a health plan is expected to pay, on average, at least as much as the standard Medicare Part D prescription drug coverage.

In any case, when you lose creditable coverage, it would be important to enroll in a Part D plan as soon as possible to avoid potential penalties. It’s always a good idea to stay informed about your particular situation and consult with Medicare or a licensed insurance professional for personalized guidance