Part D Prescription Drug Plans
Medicare Part D is the Medicare prescription drug program. Medicare Part D plans help cover the cost of outpatient prescription drugs (including many recommended shots and vaccines). Medicare Part D plans are administered by private insurance companies that follow the rules set by Medicare.
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To select a Medicare Part D plan, you will want to make sure that your drugs will be covered and we help you do that. Additionally, you will want to check the tiers and cost sharing levels of each of your drugs. There may be situations where you need to check for restrictions on specialty drugs, like Prior Authorization, Step Therapy, or Quantity Limits. In the end, we want you to be with your preferred pharmacy and to make sure that, as we shop for plans, that you have the plan that best suits your needs.
There are four phases to Medicare Part D which apply to all drug plans.
Deductible Phase - You are responsible for all costs of the negotiated medication price.
Initial Coverage Phase- You pay a co-pay or co-insurance until the retail costs of your medications reach $4,020
Coverage Gap (Donut Hole) Phase - You pay 25% of the costs of your medications until your out-of-pocket costs reach $6,200.
Catastrophic Coverage Phase - In this phase you pay 5% of the cost of your medication or a small co-pay whichever is greater.
Review Your Medicare Part D Plan Annually
Medicare Part D plans can and do change each year. So, you must review your plan options each year during the Annual Open Enrollment from October 15th through December 7th. Your current plan may not be the best plan for you every year. Check in with us and we can help you reevaluate your situation. If you do not select a new Medicare Part D plan, you will be re-enrolled automatically in your current plan. Most geographic areas have more than 20 Medicare Part D plans to choose from. We can perform a swift comparison and offer you that information as you decide.
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There are a number of ways to manage drug costs even with a Part D prescription Drug plan. Ask us about some of the creative solutions we've discovered along the way
Restrictions
Prior Authorization requires you and/or your doctor or other prescriber to complete and submit a prior authorization form to the insurance company.
Step Therapy requires you to first try another, similar drug to treat your medical condition before the insurance company will cover your drug for that same condition. For example, if your doctor prescribes Drug X and Drug Y can also be used to treat your medical condition, the insurance company may require your doctor or other prescriber to prescribe Drug Y first. If Drug Y does not work for you, or your doctor or other prescriber indicates why you cannot use Drug Y, then the company will cover Drug X.
Quantity Limits limit the quantity of a drug that the insurance company will only cover during a certain time period. Quantity Limits are generally used as a safety precaution to prevent certain prescription drugs from being used excessively.
Payment Options
You have several options for paying your Medicare Part D premiums. Medicare Part D premiums can be taken out of your Social Security payments. This is the safest option because your Medicare Part D plan can be terminated by the insurance company if you miss premium payments.
You can also pay your Part D premiums by check or by automatic bank draft.
Late Enrollment Penalties
If you don’t sign up for a Medicare Part D plan when you are supposed to, you will be subject to a late enrollment penalty when you do sign up. The late enrollment penalty is not a one-time thing; it is applied to your Medicare Part D premium each year going forward.
If you are over 65 and don’t have a Medicare Part D plan, you must start Part D coverage:
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Within two months after you lose your prescription drug credible coverage from your employer
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During the Annual Enrollment Period from October 15th through December 7th for a January 1st start date.
2022 MEDICARE PART D INCOME ADJUSTMENTS
Based on Modified Adjusted Gross Income as reported on your IRS tax return from two years ago (2020).
