Medicare Part D is Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. Part D plans are run by Medicare-approved private insurance companies.
Part D plans can be sold as standalone drug plans and paired with Original Medicare or Medigap. Meanwhile, many Part C plans include Part D coverage.
Part D plans have a premium, although you may qualify for “Extra Help” based on income to lower costs.
In terms of out-of-pocket costs, Part D plans each has a list of covered drugs called a “formulary.” Most plans then place certain drugs in levels called “tiers” and each tier has different costs in different cost-sharing phases. For example, a drug in a lower tier will have a lower cost than in a higher tier, and the cost-sharing of both drugs may be different in the initial coverage phase than they are in the coverage gap phase.
Citation: What Medicare Part D drug plans cover. CMS.Gov.
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More Facts on Medicare
Since January 1, 2023, Part D plans can’t charge you more than $35 for a one-month supply of Part D-covered insulin. You also don’t have to pay a deductible for your insulin.
Most people are not automatically enrolled in Medicare Part A and Part B and have to sign up during their Initial Enrollment Period. The following are exceptions: If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB). If you’re under 65 and have a disability. If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease). Meanwhile, Puerto Rico, has special rules for Medicare Enrollment.
Medicare Part A, Part B, and Part D all have late enrollment penalties for not signing up when you first become eligible. However, with Part A, penalties only apply to those who must pay a Part A premium. Please note each late enrollment penalty has its own rules.
Medicare Advantage plans in certain states and counties may include the Medicare Give Back Benefit. When you enroll in a Medicare Advantage plan that offers the Part B Give Back Benefit, the plan’s carrier will reimburse you for a portion of your monthly Part B premium via your Social Security check.