Medicare Part D Rules: What Baby Boomers Need to Know

Medicare Prescription Drug Plan, also known as Medicare Part D, refers to the coverage added for prescription medication for Medicare recipients. This allows those with Medicare to get insurance that will pay for part of their prescription drug costs. The insurance is available to anyone regardless of past medical history, income status, or the costs of the medications.

Medicare Part D Rules

How Does Medicare Part D Work?

Individuals who have Medicare Part A and/or B can sign up for the prescription plan each year between November 15 and December 31st. The coverage will then start in the new year following. Each plan will be set up by private insurance companies so there will variations in how the plans work. Some companies may allow purchases from certain pharmacies and other companies may only elect to cover certain types of medications. The costs associated with the plans will also differ from one to the other.

Choosing a Plan

There are several plans to choose from and it is to you benefit to read and compare each plan to see which meets your needs most accurately. There are two types of plans that offer Medicare prescription drug coverage. They are:

•Medicare Prescription Drug Plans (PDPs)

This type of plan adds drug coverage to the original Medicare plan, some Medicare Private Fee-for-Service Plan (PFFS), and Medicare Medical Savings Account Plans (MSA).

•Medicare Advantage Plans

This type of plans offer Medicare prescription drug coverage on HMO, PPO, or other Medicare health plans. These plans include Part A, Part B, and Part D coverage.

How Much Does Medicare Part D Cost?

The cost of the coverage depends on the plan you have chosen. It will also depend on the types of medications you need and if you need assistance paying for the drug costs. The majority of plans charge a monthly premium (average cost $27.93), a small co-pay for each drug, and a $275 deductible amount. If you do believe you need help paying for the medications, you can contact the Social Security office to find out if you qualify.  If you do not qualify for the payment assistance your drug plan might have a coverage gap, which is a period of time you have to pay for the prescriptions yourself. The coverage gap starts once you have spent $2700 on prescriptions. When you reach that amount you will need to continue to pay your monthly premium and the next $4,350 of your drug costs out-of-pocket. After the coverage gap limit has been reached, you have catastrophic coverage that means you only pay a small amount for each of your drugs for the remainder of the year.

How To Join Medicare Part D

Once you have selected which drug plan works for you, you can join the Part D plan by completing a paper application, contacting the company, or enrolling through the insurance company website. You can also enroll through Medicare. The Medicare website offers a plan finder comparison tool that makes it easy to compare the different plans. It is essential you find the plan that makes the most sense for you based on the drugs covered as part of the plan to get the most benefit from the coverage.

Click here for Medicare Prescription Drug Plan Finder.

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