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