Medicare Part D is the part of Medicare that’s responsible for covering prescription medications. Unlike Part A and Part B, Part D is a private insurance policy, so plans will vary in terms of coverage and cost.
How Does Medicare Part D’s Coverage Work?
Part D’s coverage is based on tiers. The lower the tier, the less expensive the medication will be.
There are four tiers:
- Tier 1 – generic (preferred)
- Tier 2 – name brand (preferred)
- Tier 3 – name brand (non-preferred)
- Tier 4 (specialty drugs)
There may be slight differences in the medications Part D plans cover. This list is known as a formulary. When enrolling in a Part D plan, one of the first questions to ask is whether your medication is covered under that plan’s formulary.
If your medication isn’t in the formulary, you may be prescribed a similar medication. If your doctor believes that you need to remain on a certain medication, you may be granted an exception.
Who Qualifies For Part D?
You qualify for Part D (or any Medicare plan) if you meet at least one of the following criteria:
- Being 65 or older
- Having a disability and receiving disability benefits for two years (if under 65 years of age)
- Receiving Social Security or Railroad Retirement Board benefits for 24 months
- Being diagnosed with a condition such as amyotrophic lateral sclerosis (ALS) or End-Stage Renal Disease (ESRD)
When Can I Enroll In Part D?
The enrollment periods for Part D are:
- Initial Enrollment Period – three months before you turn 65 to three months after
- Open Enrollment Period – October 15 to December 7
- Special Enrollment Period – begins after situations such as losing other drug coverage or moving to a new area. This typically lasts two months after such events take place
If you don’t join during Initial Enrollment Period or go without creditable drug coverage for 63 days or more, you may incur a late enrollment penalty, which is an expense added to your premium.
What If I Have Medicare Advantage?
Some Medicare Advantage plans feature drug coverage as part of their benefits. If your Medicare Advantage plan already offers drug coverage, joining a Part D plan can cause you to lose your Medicare Advantage coverage, and you’ll go back to Original Medicare (Part A and Part B).
Get Your Policy Today
At Midwest Medigap, we believe you should get the policy you need at the price you deserve. We offer policies for all needs and walks of life. When you contact us, you’ll be well on your way to getting a policy that will make your care more affordable than ever. Call us today at (515) 650-4110.
