Common questions answered about Medicare Part D

Common questions answered about Medicare Part D

Medicare health plans are government programs that provide subsidized health care services. The four parts of a Medicare plan include A, B, C, and D. While Plan A and B are offered by the federal government, Plan C and D are an extension of a Medicare plan offered by private insurers, approved by the federal government. Let’s understand Medicare Part D.

What is Medicare Part D?
Medicare Part D is a voluntary outpatient prescription drug benefit. It’s for people who already have Medicare. Basically, a Medicare drug coverage pays for all prescribed drugs you’ll need after medical treatment or even otherwise. It is wise to opt for this plan, especially if your employer or union doesn’t offer any drug coverage. A stand-alone prescription drug plan (PDP) covers prescription drugs and medications and some vaccines too. A Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits (Part A- Hospital cover, Part B – Medical and Part D).

What does Medicare Part D cover?
Medicare Plan D by all private agencies covers a wide array of prescribed drugs that are divided into classes, depending on the illness. Every plan by various private agencies covers a list of drugs, called formulary, and it varies from plan to plan. However, one thing to note is that the drugs are divided into different levels called tiers in each formulary. The cost of drugs differs depending on the tiers. In short, a drug in a lower tier will cost you less than a drug in a higher tier.

  • Formulary
    Every plan has a list of drugs that are covered. Please note that plans include brand-name prescription drugs as well as generic drug coverage. The formulary includes a minimum of 2 drugs in the commonly prescribed categories and classes,ensuring people with any kind of medical condition to get their prescribed drugs. If your specific drug is not included, a similar drug should be available in the formulary. And if the drug you need is not available or the drugs on the plan’s formulary will not suit your condition according to the prescriber, then you can also ask for an exception. Also, note that the formulary may change due to certain circumstances that include unsafe drugs, changes in medical therapies, or medical advances.

How to get Medicare part D?
You need to enroll during the enrollment period. In case you don’t enroll for plan D when you are eligible, you may have to pay an enrollment penalty. Get in touch with your existing private insurance company if you are currently on a Medicare plan and discuss the Plan D with them, and if you don’t have Medicare, you can visit their website for information. To be a part of Plan D, you must have hospital insurance (Medicare Part A) and/or medical insurance (Medicare Part B).


How much does Medicare Part D cost?
While it’s obvious that deductibles vary between Medicare drug plans, the other factors that contribute to your premium are your taxable income and marriage status (joint plan). For instance, if you file an individual tax return and your yearly income is above $88,000 up to $111,000, your monthly premium will come to $12.30 + plan premium. And if your joint tax return is between $176,000 up to $222,000, your monthly premium remains $12.30 + plan premium. Please note that these denote the numbers for 2021 as per your filing status in 2019. The monthly premium changes depending on many factors. However, no Medicare drug plan will have a deductible more than $445 in 2021 ($435 in 2020), claims Medicare.