What’s the Cost of Medicare Part D

Medicare Part D costs include the initial deductible, initial coverage limit, out-of-pocket threshold, and the coverage gap, also known as the donut hole.

For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your total out-of-pocket spending limit. Medicare Part D costs vary by policy, based on the list of covered drugs, also known as the plan’s formulary. Policies that cover prescription drugs usually put covered drugs into cost tiers, with individual cost-sharing for the medications on each tier.

Medications that fall on the higher tiers attract higher coinsurance costs and co-payments compared to those on the lower tiers. Private insurers set their own premiums, so it pays to compare plans in your area to make sure that you’re choosing the right plan for your prescription drug needs

Keep in mind, Medicare prescription drug policies and Medicare Advantage drug plans vary in terms of the particular medications they cover as well as the costs the beneficiary pays. This is despite the prescription drugs being the same.

Medicare Part D Costs depend on:

• The medications you take, and how frequently you take them
• Whether the pharmacy you go to is within the network of your plan
• Your medications are on your Part D’s formulary
• Whether you have chosen the stand-alone Part D Medicare Prescription Drug policy or the Medicare Advantage Drug Plan
• If you receive extra help paying your Part D Medicare costs

One major cost that you should consider is the monthly premium. Stand-alone Part D policies and Medicare Advantage policies have a monthly premium. Other than the monthly premiums, you may have to pay an annual deductible and a co-payment/coinsurance.

Medicare Part D Formulary for 2022

As mentioned above, each drug policy has its formulary. As a beneficiary, it’s good to check your plan’s formulary to confirm if your drugs are covered. Below are a few examples of what prescriptions are & are not covered.

Covered Prescriptions:

• Certain vaccines
• Insulin and all the equipment associated with insulin injection (needles, gauze, syringes, and alcohol swabs)
• Barbiturates
• Benzodiazepines
• Prenatal vitamins

Not Covered Prescriptions:

• Drugs for cosmetic purposes
• Medicines for anorexia, weight gain, or weight loss
• Drugs meant to relieve colds and coughs
• Medications for erectile dysfunction
• Individual outpatient drugs
• Over-the-counter medications
• Minerals or vitamin drugs except those noted in the formulary
• Fertility drugs

These are Medicare’s rules for late payments of Part D premiums:

• You can still receive coverage without penalties
• You’re granted a grace period and warning
• You receive a letter informing you to contact your plan for resolution

You must receive notification before a plan can drop you from your coverage. Grace periods can be granted and must be at least two months but can be more depending on which plan you have. The grace periods begin on day one that your premium hasn’t been paid.

FAQs

How to Get Help with Medicare Part D Costs

Our agents are here to help you find the most affordable option that will give you the most benefits. They will add all of your prescriptions to a list to make sure they are not only covered but to let you know what you can expect to pay for each one. Give us a call now, or use our compare rates form to see rates in your area on Part D plans now.

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