What You Should Know About Prescription Drug Coverage Under Medicare Part D

What You Should Know About Prescription Drug Coverage Under Medicare Part D

April 07, 20254 min read

Millions of people rely on Medicare Part D to help cover the cost of prescription drugs. But how does it work? What should you consider before enrolling? Understanding Part D drug coverage is key to making smart healthcare decisions.

For personalized guidance on Medicare Part D plans, reach out to Bourgeois Insurance at (985) 803-8999 in Thibodaux, Louisiana. We can help you find the right plan based on your needs.

What Is Medicare Part D Plan?

Medicare Part D is a prescription drug plan designed for people enrolled in Medicare Part A and Part B. This coverage helps pay for self-administered prescription drugs that Original Medicare does not cover.

Unlike Medicare Part B coverage, which includes certain outpatient medications, Medicare drug coverage under Part D is offered by private insurance companies. These companies work with Medicare to provide Part D prescription drug coverage, and they set their own prices and formularies.

Eligibility and Enrollment

To qualify for a medicare Part D prescription drug plan, you must be enrolled in Medicare Part A or Part B.

When can you enroll in Part D?

·        Initial Coverage Enrollment – When you first become eligible for Medicare

·        Annual Open Enrollment – October 15 to December 7

·        Special Enrollment Periods – If you lose creditable drug coverage, move, or have other qualifying life events

If you don’t enroll in Medicare Part D when first eligible and don’t have creditable coverage, you may face a late enrollment penalty.

Types of Drugs Covered

Each Medicare prescription drug part D has a formulary—a list of covered prescription drugs. Formularies include both generic drugs and brand-name drugs that the plan offers.

Some drugs must be covered by all plans. These include medications in six protected classes:

·        Immunosuppressants

·        Antidepressants

·        Antipsychotics

·        Anticonvulsants

·        Antiretrovirals

·        Antineoplastics (used to treat cancer)

Not sured which drugs are covered by medicare coverage? We can send you list of covered drugs. To learn more about medicare part d and part of a medicare advantage get in touch with us

Vaccines and Other Benefits

Most Medicare Part D plans must offer coverage for vaccines that Part B coverage does not include, such as shingles and Tdap.

Starting in 2021, insulin costs less than drugs for some beneficiaries, capped at $35 per month for certain plans. In 2025, new rules will lower out-of-pocket drug costs further.

Medicare Part D Costs and Financial Considerations

The Medicare Part D cost varies. Factors include:

·        Monthly Part D premium – Paid directly to the insurance company

·        Annual deductible – Some plans require you to pay a deductible before coverage begins

·        Income-based premium adjustments – People with higher incomes may pay more

Cost-Sharing and Out-of-Pocket Maximum

Medicare drug coverage includes cost-sharing like:

·        Copayments – A set amount per prescription

·        Coinsurance – A percentage of the drug cost

A big change is coming in 2025: there will be a $2,000 cap on out-of-pocket drug spending for Medicare beneficiaries. This is part of the new Part D premium stabilization demonstration, which aims to help people with Medicare afford their prescriptions. For expert guidance on Part D drug coverage, contact Bourgeois Insurance at (985) 803-8999 in Thibodaux, Louisiana. We help you compare many Medicare Part D plans and ensure you have the right coverage.

Drug Coverage Options and Flexibility

There are two ways to get Medicare drug coverage:

1.     Standalone Part D plan – Adds drug coverage to Original Medicare.

2.     Medicare Advantage plans include Part D coverage (Part C) – Combines medical and drug benefits into one plan.

Which is better? It depends on your needs! If you want lower prescription drug costs with a broader network, Part D may be best. If you want extra benefits like vision and dental, Medicare Advantage may be better.

Plan Changes and Special Enrollment Periods

You can switch Part D plans during Open Enrollment (October 15 – December 7). Special enrollment periods let you change plans if you:

·        Move outside your current plan’s service area

·        Lose creditable drug coverage

·        Enter or leave a nursing home

Plans are required to cover a variety of medications, but plan availability varies by location. Some Part D enrollees receive premium subsidies based on income.

Conclusion 

Choosing a Part D prescription drug plan is an important decision. You need to consider your medications, budget, and health needs when picking a plan.

Call Us Today

Don’t wait! Enroll in Medicare Part D to avoid late fees and ensure you have the prescription drug coverage as part of Medicare that you need. Call Bourgeois Insurance at (985) 803-8999 today!

 

Price Started in the insurance industry over 20 years ago. Working for several well known large corporations over the years but found he could serve his clients and community better as an Independent Agency offering Medicare Supplements (Medigap), Medicare Advantage Plans, Prescription Drug Plans (PDP), and Retirement Planning Services.

Price has spent years building one of the top agencies in the Thibodaux, Louisiana. Dedicated to finding the best solutions and staying up to date on insurance trends and products.

Price Bourgeois

Price Started in the insurance industry over 20 years ago. Working for several well known large corporations over the years but found he could serve his clients and community better as an Independent Agency offering Medicare Supplements (Medigap), Medicare Advantage Plans, Prescription Drug Plans (PDP), and Retirement Planning Services. Price has spent years building one of the top agencies in the Thibodaux, Louisiana. Dedicated to finding the best solutions and staying up to date on insurance trends and products.

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