What is Medicare Part D?

Medicare Part D is a federal program administered by private insurance companies. These private insurance plans can help lower your out-of-pocket costs for prescription drugs. Before  Part D was introduced in 2006, all costs were out-of-pocket. 

How and when can I enroll in a Part D plan?

You have a couple options for enrolling in a standalone Part D drug plan:  

  • A beneficiary on Original Medicare may receive Part D prescription drug coverage through a stand-alone prescription drug plan (PDP).
  • A beneficiary may also receive drug coverage through a Medicare Advantage health plan (MA-PD).

With the exception of those who are eligible for both Medicare and Medicaid, you must actively select a Part D Plan. When you turn 65, you’ll enroll in Part D during your initial enrollment period. This is a 7 month period that includes the 3 months before the month you turn 65 and the 3 months after. Outside of this period, you’ll generally enroll or change your Part D Plan during the fall Annual Election Period that begins on October 15 and ends on December 7. All elections are effective on January 1 of the following year. 

What are the costs of a Part D Plan?

When selecting a PDP, you should consider monthly premiums, deductibles and cost sharing, formulary, and network pharmacies. It’s important you consider the prescriptions you take and access to nearby pharmacies when selecting a plan. 

Prescription drug plans commonly use a drug formulary and tiered cost system for covered drugs. Many plans group drugs into 5 tiers based on cost. For example:

  • Tier 1: Generic drugs
  • Tier 2: Non-preferred generic drugs
  • Tier 3: Preferred brand-name drugs
  • Tier 4: Non-preferred brand-name drugs
  • Tier 5: High Cost specialty drugs

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AHIC is here to walk you through the process of applying for Medicare or shopping for the plan that’s right for you. Our services are free for you and we’ll be here to help for the lifetime of your policy.

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