7 Dec

Medicare Part D Plans: Frequently Asked Questions

Healthcare is a costly affair today and if you are not properly insured, you will have a tough time paying medical bills during emergency health situations. Medicare plans are a boon for people aged 65 and above in today’s times of expensive healthcare. Medicare is a national social insurance program that includes around 50 insurance companies all across the United States. There are 4 different parts namely A, B, C and D in Medicare.

Medicare Part A and B plans are the most commonly used plans, which cover hospital and medical insurance respectively. Medicare Part D Plans cover prescription drug expenses for existing Medicare beneficiaries. If you don’t have a Medicare Part D plan, you will most certainly have a lot of questions. Read this article to get answers to all of your questions.

1. What exactly is a Medicare Part D Plan?

It is one of the plans of Medicare that came into effect on January 1, 2006. It essentially acts as an insurance coverage for prescription drugs and anybody who has Part A or Part B plans with them are eligible for Part D as well. Part A and B don’t cover prescription drugs and some treatments require that you to consume a lot of medicines, normally expensive ones. Part D plans come handy in such situations.

2. What do Medicare Part D Plans cover?

Part D plans mainly provide insurance coverage for prescribed drugs from your doctor. There are different plans which cover different drugs and you will be able to choose a particular plan that covers most of your prescribed drugs. You won’t receive any coverage for non-prescription drugs like weight gain/loss drugs, cosmetics, medicines for hair growth etc. Drugs that are covered by Part A and Part B plans are also excluded from the coverage offered by Part D plans.

3. How much do Medicare Part D Plans cost?

Like every insurance coverage, you have to pay a monthly premium on your Part D plan. The average nationwide premium as of 2017 is $34. However, monthly premiums largely depend on the insurance company and the type of drugs you are taking. Apart from monthly premiums, you will also have annual deductibles if you are consuming drugs that are considered high tiered. High tier drugs are those drugs that are expensive and given to treat complex health issues.

4. What are the coverage limits?

All insurance plans have coverage limits and so do Medicare Part D Plans. For 2018, the coverage limit is $3750. This means that once your drug expenses reaches this number, you will have to pay 44% of the co-insurance on generic drugs and 35% co-insurance for brand name drugs. The rest will be paid by the Medicare plan. If your yearly out of the pocket expenses on prescription drugs reaches $5000 you will have to pay an additional $3.35 co-insurance on generic drugs and $8.35 for all other drugs.

5. What are the limitations I need to know?

Like every insurance plan, Medicare Part D plans too have their own internal network of pharmacies from where you can buy your prescription drugs. Each plan will have a certified network of pharmacies that will be considered internal. If you choose to purchase your drugs elsewhere, it will be considered an out-of-network purchase where your share i.e. the co-insurance will be more. You should be careful while choosing the plans as well since each plan will have a set of drugs grouped together, consisting of lower and higher tier drugs.

6. When can I join a plan?

You can sign up for Medicare Part D plans (www.wisegeek.com/what-is-medicare-part-d.htm) in three different ways. If you are new to Medicare plans, you can sign up for Part D under an Initial Enrollment Period (IEP) which stretches from 3 months before your birthday month and 3 months after your birthday month, i.e. a total of 7 months. Or you can also sign up during the Annual Enrollment Period (AEP) which runs from October 15th to December 7th. Lastly, you can also sign up under the Special Enrollment Period (SEP) anytime of the year only under special circumstances like losing your employer drug coverage.


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