Medicare Part D
What is a Medicare Part D?
Part D is the Medicare prescription drug program. You can obtain the benefits through a Medicare Advantage plan or through a stand alone Part D plan. You can not enroll in a Medicare Advantage plan that does not include Part D and enroll in a stand alone Part D plan. The only exception is if you enroll in a Private Fee for Service(PFFS) without prescription drug benefit. In this scenario, you would be able to enroll in a stand alone Part D plan.
To enroll in a stand alone Part D plan you need either have Part A or Part B. If you don’t enroll in a Part D plan when you first become eligible and choose to enroll at a later date, you may be assessed a late enrollment penalty. The exception would be if you have creditable drug coverage. Creditable drug coverage is as good or better than the Part D benefit.
Each Part D plan has a drug formulary. The formulary is the list of drugs that the plan covers. If your drug is not on the plan’s formulary, you can request an exception.
Part D Costs:
- Most Part D plans require a monthly premium.
- Some Part D plans have deductibles.
- Many Part D plans require you to pay a fixed copayment amount or coinsurance every time you fill a prescription.
Part D Stages:
- Deductible period – If your plan has a deductible, you pay full price until deductible is met. The deductible cannot be higher than $545 in 2024.
- Initial coverage period – After deductible is met, you will pay your plan’s copayment or co-insurance. For most plans, the initial coverage period ends after you have accumulated $5,030 in total drug costs(2024). Total drug cost is what you pay and what the plan pays.
- Coverage gap – After your total drug costs reach $5,030 in total drug costs, you enter the coverage gap or donut hole. In the donut hole, you will be responsible for 25% of the cost of your drugs. The coverage gap or donut hole will be eliminated as of 1/1/2025.
- Catastrophic coverage – You will enter the catastrophic stage once total drug costs reach $8,000. During the catastrophic stage, you will pay $0 for your Part drugs for the rest of the year. In 2025, the catastrophic stage will begin at $2,000.
Low Income Subsidies(LIS)
- LIS or extra help is a federal program that helps pay some or all of the Part D costs for people who qualify. Eligibilty is based on your income and assets.
- You can visit a local Social Security Administration office or www.ssa.gov to apply for extra help.
There are about 20 stand alone Part D plans offered in Florida in 2024. If you have Original Medicare and are shopping for a Part D plan and would like to compare the plans, please contact us.
