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Medicare Part D – 5 Things You Should Know

Joining a Medicare Part D plan requires that you already have Medicare Part A and B.   Availability of plans is going to depend mostly on where you live since most plans will require that you live in the “service area”.  There are plenty of national, regional, and local  prescription drug  plans to choose from. A helpful agent should be able to put together some side by side comparisons of the different plans to help you choose an affordable health insurance plan that fits your needs. People with limited incomes may be eligible for “Extra Help”. If you qualify, “Extra Help” will help you pay your premiums, deductibles, and copays.  “Extra Help” also eliminates the late enrollment penalty and the coverage gap. Here are five things you should make sure you understand when choosing a Medicare prescription drug plan.

  • If you don’t enroll in a Medicare Part D prescription plan when you first become eligible then you will pay higher premiums if and when you do eventually enroll. This is known as the “late enrollment penalty”. Sometimes it makes sense to wait and just pay the late enrollment penalty.  It really depends on your health and your budget.
  • Depending on the plan you choose you have a monthly premium, annual deductible, copayments, coinsurance, and “coverage gap”. Make sure you completely understand the coverage gap or “donut hole”, copayments, and your deductible. The “coverage gap” will also be changing as the legislation from the Patient Protection and Affordable Care Act comes into effect.
  • Medicare drug plans classify all the prescription drugs into different tiers.  Each tier has a different cost, lower tiers cost less and higher tiers cost more.  These rules are subject change as Medicare is modernized.
  • Medicare prescription drug plans also cover commercially available vaccines if they are medically necessary. 
  • Your share of the costs for your medications on your Medicare Part D Prescription Drug plan will vary from plan to plan.  You should evaluate your plan each year to make sure you are minimizing your out of pocket costs.

“Medicare and You” is a publication created by the Center for Medicare and Medicaid Services that provides detailed information about Medicare insurance, Medicare Supplement plans, and other valuable information.  Ask your health insurance agent for a copy. Changing plans is subject to restrictions and there are lock in periods.  Don’t get stuck in a plan that doesn’t fit…ask questions.  There are several resources available to you help you choose a  Medicare Part D plan. 


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