Medicare Part D adds prescription drug coverage to Medicare or Medicare Advantage plans. Prescription drug plans are offered by private insurance companies that are approved by Medicare. Each plan can vary in cost and drugs covered. NIBC can help you navigate these drug coverage plans and decide which one is best for you.
How To Get Medicare Drug Coverage
You must have Medicare Part A and/or Part B to join a separate Medicare drug plan. Some Medicare Advantage plans offer drug coverage. To enroll for Medicare Plan D, you can enroll during your Initial Enrollment Period. Your IEP for Part D is usually the same as Part B – the seven month period that includes the three months before the month you’re eligible, the one month you become eligible when you turn 65, and the three months after you become eligible. If you don’t join a Medicare drug plan during your IEP, you will have to wait until the Fall enrollment period from October 15 through December 7.
Annual Deductible
1You will pay the full cost of your prescriptions until they add up to meet your plan’s deductible. Some plans have a $0 deductible.
Initial Coverage
2This begins once you meet your deductible for the year. Your plan will pay for a portion of the prescription drug as long as it is covered by your plan’s formulary, or list of covered drugs. You are responsible for paying the other portion, which is either a set dollar amount, or copayment, or percentage of the cost, or coinsurance. This ends once you and your plan spend on covered drugs adds up to the initial coverage limit set by Medicare. Your monthly premiums do not count toward this limit.
cOVERAGE gAP ("DONUT HOLE")
3This begins once you and your plan reach your initial coverage limit for the year. Not everyone reaches this stage. If you do enter this stage, you will pay 25% of the plan’s cost for brand name drugs and 25% of the cost for generic drugs until your out of pocket costs on drugs reaches $7,400.
Catastrophic Coverage
4After spending $7,400 out of pocket on drugs, you receive catastrophic coverage. You will pay a low coinsurance or copayment amount that is set by Medicare for all of your covered prescription drugs. The plan and the government will pay for about 95% of the cost. This stage lasts until the end of the plan year.
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If you have any questions regarding insurance options for yourself, your loved ones, or your employees give us a call today, or contact us to receive a free insurance quote!
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 to get information on all of your options.