Medicare Part D

Medicare Part D Prescription drug plans, also referred to as Medicare Part D, helps cover the cost of medications for Medicare beneficiaries. Part D plans are available and administered by private insurers with a Medicare contract. There are two ways you can get Medicare Part D drug coverage. First, is through a stand-alone Part D prescription drug plan. Secondly, you can get coverage through an all-in-one Medicare Advantage Prescription drug plan, also known as an MAPD plan.

Medicare Part D Eligibility

To be eligible for enrollment into a Part D plan, you must be entitled to Medicare Part A and/or enrolled in Part B. Likewise, you must permanently reside in the plans service area. Finally, you must be a US citizen or lawfully present in the US.

Important to note- if you do not join a Medicare drug plan when you are first eligible, you will likely pay a late enrollment penalty if you join a plan later. A late enrollment penalty is generally applied if you do not join a Part D plan within 3 months of your Part A or Part B start date.

Generally, you pay the late enrollment penalty for as long as you have Medicare prescription drug coverage. Exceptions apply for those who qualify for extra help with their Part D coverage, as well as those with other credible drug coverage. The penalty is 1% of the current national base beneficiary premium times the number of months you were uncovered. The national base beneficiary premium changes annually, thus the late enrollment penalty updates yearly.

Medicare Drug Plan Costs

Different insurers offer different types of plans, thus monthly premiums and out-of-pocket costs for medications vary from plan to plan. Cost considerations may include:

1. Whether or not a plan covers a specific medication.
2. Pharmacy preference.
3. Whether a member qualifies for extra help with their Part D drug costs.
4. The plan itself. All drug plans charge a monthly fee that varies substantially by plan. Cost sharing amounts also vary from carrier to carrier. Cost sharing may include deductibles, copayments, coinsurance, and extra coverage in the coverage gap.

Please note… if your modified adjusted gross income is greater than the specified threshold amount, you are responsible for a larger portion of your Part D coverage costs. Also referred to as IRMAA or the Part D Income-Related Monthly Adjustment Amount, this amount is in addition to your Medicare Part D premium. IRMAA is based off the modified adjusted gross income (MAGI) reported on your tax return from 2 years ago. If your income surpasses the threshold amount, you will automatically be notified by the Social Security Administration.

Need help comparing your Medicare Part D prescription drug options? Call 813-280-9560 to speak to a licensed & certified Medicare insurance agent.

“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.”