Medicare Part D (Prescription Drug Coverage)
The Part D monthly premium varies by plan (higher-income consumers may pay more).
Cost: You’ll make these payments throughout the year in a Medicare drug plan:
• Yearly deductible
• Copayments or coinsurance
• Costs in the coverage gap
• Costs if you get Extra Help
• Costs if you pay a late enrollment penalty
Your actual drug plan costs will vary depending on:
• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan’s network
• Whether the drugs you use are on your plan’s formulary
• Whether you get Extra Help paying your Medicare Part D costs
Look for specific Medicare drug plan costs, and then call the plans you’re interested in to get more details.
What is covered: Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. Your prescriber may think you need a drug that’s on a higher tier. If so, you or your prescriber can sometimes ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
Provide written notice to you at least 60 days prior to the date the change becomes effective.
At the time you request a refill, provide both of these:
A written notice of the change
A 60-day supply of the drug under the same plan rules as before the change
If you didn’t enroll in prescription drug coverage– either through a PDP or a Medicare Advantage plan— during your initial open enrollment window and then you enroll during a general open enrollment period in a later year, there’s a late enrollment penalty that will be added to your premium (the late enrollment penalty does not apply if you delayed your Part D enrollment because you maintained creditable drug coverage from another source– like an employer-sponsored health insurance plan).
The Part D late enrollment penalty would also apply if you drop your prescription coverage for more than 63 days and then re-enroll during a general open enrollment period. It’s important to maintain continuous drug coverage from the time you’re first eligible, both to protect against significant prescription costs and also to avoid higher premium when you ultimately re-enroll.