Medicare Part D
What is Medicare Part D?
Medicare Part D is prescription drug coverage for outpatient medications. It is provided through private insurance companies that are contracted with the federal government.
How do Medicare Part D plans work?
Insurance companies offering Part D plans must provide at least the standard level of coverage (cost to enrollees, drug categories) set by Medicare each year.
However, plan designs vary in terms of premiums, deductibles, copays, pharmacy networks, and specific drugs covered.
Part D plans have four levels of coverage: Annual Deductible, Initial Coverage, Coverage Gap, and Catastrophic Coverage. How many of those levels you experience during a calendar year depends on your drug costs.
What are my coverage options?
Medicare Part D coverage is offered through stand-alone plans (PDPs) or is included in Medicare Advantage coverage in MAPD plans.
Whether you are interested in a stand-alone PDP or an MAPD, the first step in determining the best drug coverage for you is to find out how your current prescription medications would be covered under the plans available in your zip code.
To get started comparing available plans, click the box below or call 877-312-1414 to have a licensed broker prepare a plan comparison for you!
How do I enroll in a Medicare Part D plan?
Most Medicare Part D plans are not open to new enrollments year round.
There are specific times and circumstances that allow you to enroll.
1
Initial Enrollment Period (IEP)
If you are enrolling in a Medicare Part D plan when you turn 65 and are enrolling in Medicare Parts A and/or B, your IEP is the three months prior to your birth month, your birth month, and the three months following your birth month, for a total of seven months.
2
Annual Election Period (AEP)
Every year beginning October 15 and ending December 7, you can add, change, or drop your Medicare Part D coverage. Any changes will be effective January 1.
3
Special Election Period (SEP)
Many things can trigger a special election period, and these situations are unique to each individual. Some of the most common include moving out of your current plan’s service area, qualifying for extra financial help, moving into or out of a nursing home, or your current plan leaving the program.
What About……?
This amount is added by Medicare to your Part D premium if you have 63 or more consecutive days without Part D or creditable coverage in place after the end of your IEP (generally, 4 months after your 65th birthday).
The penalty is 1% of the national base beneficiary premium multiplied by the number of months you did not have creditable coverage. This amount is added to your monthly premium every month for as long as you are enrolled in a Part D plan.
The Coverage Gap has been eliminated beginning January 1, 2025.
Some Medicare beneficiaries pay higher Part D premiums based on their income. If you are required to pay this amount, Social Security will send you a letter explaining the charge.