Part D
Medicare Part D makes your prescription drugs more affordable. With it, you’ll receive help and see a substantial positive impact on your Medicare costs.
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Medicare Part D
Coverage
What exactly does Medicare Part D cover? When you enroll in a plan, you will receive a list of the plan’s accepted, covered drugs that you will be able to access. This is known as the plan’s formulary.
In this formulary, there are 5 tiers. These tiers categorized the covered prescriptions into different cost brackets. Tier one covers any drugs that are considered preferred and generic. This means that the doctors in your coverage radius “prefer” the drugs over their competitors. “Generic” means that the drug is identical to its brand name, more expensive counterparts.
Tier two includes non-preferred generic, i.e. prescriptions that are still cheaper yet identical it’s to brand-name counterparts but not preferred by doctors.
Tier three includes preferred brand-name drugs. You will be prescribed these if the prescription you need is not available in a generic drug, but still preferred by doctors.
Tier four includes non-preferred brand names. These are prescribed if a preferred counterpart does not exist.
Tier five is a unique tier, as it only covers “specialty” drugs. These are only necessary for specific conditions such as cancer.
Medicare Part D Costs
Medicare Part D costs are based on premiums, deductibles, and cost-sharing fees. Cost-sharing fees, either coinsurance or copayments, are paid out-of-pocket each time you fill a prescription. The exact amount you pay depends on the tier it falls into—tier one being the least expensive, tier five being the most.
Your premium and deductible payments depend on the provider you choose. Some plans are better than others. If you are looking for a Part D plan, be sure to shop around and compare options available in your area.
If you know that you need a lot of prescription drug coverage, you should be aware of the Part D “donut hole.” When the plan spends a certain amount on your coverage, you will enter the “donut hole,” which is currently $4,130 in a year. You will leave the hole and enter “catastrophic coverage” when you spend a total of $6,550 out-of-pocket.
If you need additional help covering the various costs of a Part D plan, you may be eligible for the Part D Extra Help program. While enrolled, your costs will be significantly reduced.
Enrolling in Part D
Virtually everyone eligible for Medicare can enroll in a Part D plan. When you first become eligible at age 65, you can enroll in a plan in addition to your Original Medicare coverage, or through a Medicare Advantage plan that includes Part D coverage. If you’re past initial enrollment, you can add it to your coverage during the Annual Enrollment Period (AEP).
Explore Part D with BIM
BIM will help you find the best Part D coverage in your area. Call today at (732) 458-5000.
