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Which Coverage Does Medicare Part D Provide?

Packaged prescription pills

Medicare Part D Essential Facts

In this brief article, we’ll talk about the coverage Medicare provides under Part D Prescription Plans, what you might pay, and essential tips to help you stay in-the-know.

Which Coverage Does Medicare Part D Provide?

Medicare Part D provides you with optional coverage for some—if not all—of your prescription drug expenses. There are two ways to obtain it:

First, the Centers for Medicare and Medicaid Services (CMS) offers Part D Prescription Drug Plans to all eligible individuals, and attaches it to Original Medicare (Part A  and Part B).

Alternately, you can purchase a Medicare Advantage (Part C) Plan from a third-party insurance company (e.g., HMO or PPO), who rolls your Part A, Part B, and Part D together under a single policy.

Related: Podcast – What Are the Different Parts of Medicare?

And based on your specific needs, these carriers offer different plans with a range of coverage options.

IHS Pro Tip: Regardless of your needs and the plan you choose, in most cases, you can only enroll (or change) your Medicare Part D coverage during the open enrollment, which occurs between October 15th and December 7th.

Related: How You Can Easily Enroll in Medicare

What happens if you don’t enroll? We’ll cover this topic next.

What is Medicare’s Enrollment Penalty?

If you’re eligible for a Medicare drug plan and you don’t enroll, and if you don’t qualify for—and receive—extra help or have prescription coverage elsewhere, you’ll be subject to a monthly penalty once you do enroll.

What is credible coverage? Medicare broadly defines it as “coverage from an employer or union that at least meets the standards of Medicare prescription coverage.”

Furthermore, they emphasize that you’ll continue paying this penalty each month for as long as you have Medicare prescription drug coverage.

Bottom line: Unless you want to pay a permanently higher rate (more soon), you must reach out to IHS Insurance Group when it’s time to obtain Medicare prescription drug coverage!

What Is Medicare’s Part D Donut Hole? 

Whether you opt for a plan through the government or a private insurance carrier, Medicare Part D coverage includes a “Donut Hole” that temporarily limits how much policies will pay for drugs.

In other words, once the company pays a specific amount for your covered prescription medications, your out-of-pocket costs will increase.

According to the Medicare.gov website, items that move you closer to your Donut Hole include your yearly deductible, coinsurance, and copayments, as well as brand-name drug discounts. 

What you pay toward your plan’s premium and non-covered drugs do not count toward your coverage gap.

In layman’s terms? You’ll temporarily pay more for meds covered under your plan once its Donut Hole kicks in.

The good news is that not everyone reaches their Donut Hole, so just because you enter it one year doesn’t necessarily mean you will the following year. Furthermore, your coverage for drugs while in the Donut Hole will increase each year until the gap closes in 2020.

What Can You Expect to Pay For Your 2019 Medicare Part D Premium?

As we explain in What You Need to Know About Medicare Prescription Plans, your Part D premium is based primarily on the medications you’re taking. And because everyone’s meds are different, so are everyone’s premiums.

Furthermore, regardless of the plan you choose, coverage amounts typically change each year. As such, what you pay for medication now will likely change once your policy comes up for renewal.

Multiple additional factors can affect how much you pay, including:

  • If the carrier charges a monthly fee for your plan
  • Your deductible
  • If you choose in-network vs. out-of-network pharmacies
  • Whether you purchase generic or brand name medications, and their related copayments/coinsurance
  • If you’re subject to an enrollment penalty
  • If you’ve reached your coverage gap (Donut Hole). In this case, you’ll pay “no more than 25% of the plan’s cost for covered brand-name prescription drugs.”
  • Your modified adjusted gross income
  • Whether or not you qualify for Medicare’s Extra Help program

Based on 2017 data, though, the Medicare.gov website indicates that you’ll pay anywhere from just your plan premium, to your premium plus $77.40 each month, depending on your annual income.

Additionally, they point out that for 2019, deductibles ranged between $0 and $415.

Do You Need Help Selecting a Medicare Part D Prescription Drug Plan?

You can see that Part D is equally as complex as any other portion of Medicare, which is why it’s vitally important that you rely on the helpful professionals at IHS Insurance Group when making an informed decision.

We can help you select from a wide variety of inexpensive Part D plans with well-rounded coverage that meets your unique needs.

Need a FREE Quote or have questions regarding Medicare Coverage? We have three convenient ways to reach us:

  1. If you prefer to talk to a licensed agent directly, please call (866) 480 5063.
  2. If you prefer to fill out a quick form and have an agent get back with you at your convenience, use the GET A FREE QUOTE.
  3. Lastly, for those that want an immediate quote, please click HERE.

Also, check out our Medicare FAQ’s here.

Inforgraphic of Medicare Part D details, including prescription coverage, late enrollment, and premium.