10 Things you Should Know About Medicare Part D
  • November 16, 2020
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Medicare Part D: 10 Things you Should Know

There’s a lot to know when it comes to Medicare Part D. Choosing the right plan can seem like an overwhelming task.  Understanding the details of Medicare Part D can help you make an informed decision that is best for you and your health.  To help with the process, we’ve compiled a list of ten frequently asked questions of Medicare Part D that you should know before making a decision.

1. What is Medicare Part D?

Medicare Part D, often called a prescription drug plan, is an insurance plan offered under Medicare through private insurers to help pay for the cost of prescription drugs.

2. When do I need to enroll in Medicare Part D?

Enrolling in Medicare Part D is optional.  If you choose to enroll in a Part D plan, you will need to do so during your Initial Enrollment Period (IEP) to avoid any late enrollment penalties.  The initial enrollment period is an eight-month time-frame beginning three months before your birthday, running through your birth month, and ending three months after your birthday.

If you choose to enroll in coverage at a later date you may be subject to late enrollment penalties.  Late enrollment penalties can be avoided if you qualify for a special enrollment period and can prove you had credible drug coverage.

3. What does Medicare Part D cover?

Each plan varies on the type of coverage and prescription drugs they offer.  Medicare requires all plans to carry a wide range of prescription drugs including most drugs that are part of certain protected classes (HIV/AIDs  & cancer medication).

4.  What does Medicare Part D not cover?

Certain drugs are excluded from Part D coverage such as:

  • Over the counter drugs (antacids, cough syrup, etc.)
  • Drugs used for cosmetic purposes or hair growth
  • Drugs used to treat weight issues (weight loss or weight gain)
  • Drugs used to treat erectile dysfunction
  • Prescription vitamins
  • Fertility drugs

5. Can I switch my Part D Drug plan?

Yes.  Every year those enrolled in a prescription drug can plan can switch to a different plan during the Annual Enrollment Period (AEP).  AEP runs from October 15th through December 7th.

6.  What is the Part D “donut hole”?

The Part D “donut hole” refers to the stage in Medicare Part D reached after you and your plan have spent a certain threshold of money.  The “donut hole” is often referred to as a coverage gap.  When you have reached the gap in coverage of your prescription drug plan you will most likely have to pay more for your prescription drugs.  The threshold for 2020 was $4,020.

7.  What is the difference between a Prescription Drug Plan (PDP)  and Medicare Advantage Prescription Drug Plan (MA-PD)?

A Medicare Advantage prescription drug plan combines prescription drug coverage with the benefits of Medicare Part A and Part B.  Some Medicare Advantage plans also offer other benefits such as vision and dental.  A Prescription Drug Plan is a stand-alone plan that offers only prescription drug coverage.

8. How much does a Part D plan cost?

The cost of Part D varies depending on the plan you choose and how many prescription drugs you take during the year.  According to the Center for Medicare & Medicaid Services (CMS), the average monthly premium for a Part D plan in 2021 will be $30.50. However, premiums can change based on the plan you choose, for example, some Medicare Advantage plans include prescription drug coverage in their premiums.   Other costs to consider when choosing a plan are:

  • Annual deductible
  • Copay
  • Coinsurance
  • Coverage Gap

9. What if I can’t afford a prescription drug plan?

If you can’t afford a Medicare Part D plan you may qualify for Medicare’s Extra Help program.  The Extra Help program helps individuals with limited income and resources pay for their prescription drugs.

10. How do I decide which Medicare Part D plan is best for me?

Choosing a Medicare Part D plan can seem confusing.  Fortunately, there is help.  Independent Insurance Agents specializing in Medicare are a great resource to use while navigating the various plan choices. At Griset Medicare Solutions, we get to know your needs and preferences and shop all available plans to find the best option for you.  No fee, no obligation, no confusion!


Need Assistance in Choosing a Medicare Part D Plan?

Speak with a qualified independent Medicare-focused insurance agent in your area about which plan is right for you. Call us at (714) 834-1322.

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