Medicare Part D

Medicare Part D provides prescription drug coverage for a variety of needs and costs. Get the Part D guidance and plan you need by calling Medicare Detectives today.

Medicare Part D Definition and Eligibility

With Medicare Part D, you can get coverage for your prescriptions. It is an optional addition to your Original Medicare plan, but it may also be included as an additional benefit with a Medicare Advantage plan. Now, while these plans are not required, it is recommended that you purchase one. For example, if you are in an accident and need medication, the result of not having Part D coverage is the cost that will have to be paid out-of-pocket, leaving you financially exposed. You will also be penalized if you choose to delay your Part D enrollment and enroll at a later date.

To be eligible for Part D coverage, all you have to do is enroll in either Part A or Part B.

Part D Coverage

Part D covers a huge variety of prescription drugs, including:

  • Cancer treatment drugs
  • Mental health prescriptions, such as antipsychotics and antidepressants
  • Immunosuppressants
  • Anticonvulsants
  • Antiretrovirals

However, there are some specific drugs not covered by Part D. These include:

  • Weight gain or weight loss drugs
  • Fertility drugs
  • Drugs for sexual performance or erectile dysfunction
  • Over-the-counter drugs

Covered drugs will vary based on the formulary of your plan. Each formulary offers at least 2 or more prescription options for common ailments and needs, meaning that your health concerns should be covered. And, if you require a specific drug, Part D plans include a specialty tier with a higher cost-sharing amount.

Part D Costs

Part D formularies are organized into tiers. The higher the tier, the more you will pay out-of-pocket in a copayment known as cost-sharing. The 4 tiers include:

  • Tier 1 — Preferred generic prescriptions with the lowest copayment
  • Tier 2 — Preferred, brand-name prescription drugs with medium copayments
  • Tier 3 — Non-preferred, brand-name prescription drugs with higher copayments
  • Tier 4 (Specialty Tier)— high-cost prescription drugs with the highest copayment
 

Part D Extra Help

For many individuals, the cost of a Part D plan is affordable. But, if you cannot afford Part D, you may want to consider the Part D Extra Help Program.

If you fall under a certain income level, you will qualify for Extra Help. This will cover most, if not all, of your Part D costs. You can apply for Extra Help on the Social Security website or over the phone. Or, you can reach out to the Medicare Detectives to help you with this process!

Put Your Medicare Coverage Into Trustworthy Hands—Call Medicare Detectives

When it comes to Medicare Part D, you may feel a bit overwhelmed. Or, perhaps you are ready to enroll,  but just don’t know where to start. No matter where you are, Medicare Detectives are here to help. Give us a call today so we can help you get the coverage you need!