Medicare Part D
Medicare Part D covers most retail prescription drugs and vaccines. Prescription drug plans (PDPs) give you access to outpatient medications at more affordable prices. These plans are offered by private insurance companies approved by Medicare.
Many PDPs are available in most states. The right plan for you will depend on the prescriptions you need. When you need help finding prescription drug coverage, reach out to Simple Retirement Benefits.
How Can You Get Medicare Part D Coverage?
While Medicare Part D is optional, your drug costs could be significant without coverage.
Medicare recipients can get prescription drug coverage in two main ways:
- Add a separate Part D plan to your Original Medicare, or
- Get an Advantage plan (such as a PPO or HMO) that includes drug benefits. These are sometimes called MA-PDs.
We can help you see which PDPs offer the prescriptions you need at low rates.
What Medicare Part D Covers
Part D helps you pay for generic and brand-name drugs, so most outpatient medications will be covered.
Each plan has a formulary, or list of medications covered. The formulary may change at any time, but the carrier will let you know when they expect to make changes. If your prescription isn’t listed, you may need to send in an appeal or pay for the drug yourself.
PDPs will cover nearly all drugs in the following categories:
- Anticancer
- Antipsychotics
- Anticonvulsants
- Antidepressants
- Immunosuppressants
- Antiretrovirals (AIDS treatment)
Medicare PDPs must also cover most vaccines except for the ones covered under Part B.
What Part D Does Not Cover
Different plans offer different coverage. However, some drugs will likely be left out of all PDPs, including:
- Fertility drugs
- Over-the-counter drugs
- Any drugs for hair growth
- Erectile dysfunction drugs
- Drugs for weight loss or weight gain
Note: Original Medicare may cover certain prescriptions or cover your medications in specific circumstances.
How Does Part D Cost-Sharing Work?
When you get your prescriptions from the pharmacy, you’ll pay your share of the expenses. Some plans have a deductible, and then you’ll have copayments for the prescription itself.
Medicare Part D Costs
The cost of your plan depends on which one you choose. It also depends on your income and whether you qualify for Medicare’s extra help program. Your monthly premiums will vary by plan.
When Should You Enroll in Part D?
We suggest you enroll when you first get Medicare, during your Initial Enrollment Period. This is a seven-month window. If you delay Part D enrollment, you could face penalties and coverage gaps — unless you have creditable drug coverage and are given a Special Enrollment Period.
You can also enroll or disenroll from any Medicare drug plan during the Annual Election Period. It’s October 15 to December 7.
How Should You Enroll in Medicare Part D?
You’ll enroll in the plan’s service area (where you live). If you need guidance or have any questions, don’t hesitate to contact an agent.
Contact Simple Retirement Benefits for Help
Medicare Part D is complicated, but we’re here when you need help. Simple Retirement Benefits can provide you with info on the specific PDPs in your area. Then, we’ll help you select a plan based on your budget and current prescriptions. Call 512-432-5414 or contact us online!
