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What to Know about Medicare Part D

Updated: Jul 29

In healthcare delivery, prescription drugs form a considerable portion of the overall cost.


Established by law in 2006, Medicare’s Part D health insurance package is designed specifically for this reason- to offset the financial burden of out-of-pocket prescription expenditure.


The rates and coverage vary according to your chosen plan, so you must consider options carefully before subscribing to a Medicare drug coverage plan.


Coverage and rates can vary based on your chosen plan, and it’s essential to check all the options before choosing a Medicare Part D plan.



What exactly does the Medicare Part D plan cover?

Below is a list of prescribed medication categories covered by Medicare Part D. Note that each plan must provide coverage for a minimum of two of these:

  • Antidepressants

  • HIV medication

  • Anticonvulsants

  • Immunosuppressants

  • Antipsychotics


Eligibility

To be eligible for Medicare Part D, you must be entitled to Medicare Part A or enrolled in Medicare Part B and you must live in the designated geography of the plan you want to enroll in.


You have to be at least 65 years old to qualify or have been collecting Social Security disability benefits for a minimum of two years prior regardless of age.


There are exceptions to this condition if there’s a diagnosis of chronic kidney disease.


Enrollment

With Medicare Part D, you may incur higher premiums as a penalty if you wait for 63 days, delaying enrollment to a prescription drug program after attaining the age of eligibility.


In addition, you can enjoy subscriptions to Medicare Parts A and B concurrently with Medicare Part D. You should also note that the plans change annually.


Here are some other interesting things to know about Medicare Part D:


The plan does not cover the total cost of drugs

Part D is also referred to as the Medicare drug coverage, making up for Medicare Parts and B deficit medication. However, you should know that Medicare Part D coverage is not comprehensive regarding drugs.


It actually covers 75% of the overall cost, meaning that you’ll have to foot a quarter of the bill, with the additional payments made up of deductibles, copays, and premiums.


It does not cover outpatient treatment

Outpatient treatments fall under the denomination of Medicare Part B rather than Part D.


If you go to the hospital to receive treatment as an outpatient, Medicare Part D covers the cost of the prescription drugs.


However, there's no coverage if you go to other outpatient facilities for more specialized treatments like dialysis and chemotherapy.


Nevertheless, Part D exceptions are made for certain self-injected medicines like insulin.

There are standalone Medicare Part D plans

Different insurance companies offer the sole drug coverage plan to complement the traditional Medicare service.


For instance, many Medicare Advantage packages cover inpatient doctor examinations and hospital care in addition to the drugs. Ensure that the terms of each plan are favorable for you.



Generic drugs and brand names

Although Medicare Part D doesn’t cover prescription drugs like Viagra and drugs for weight loss and hair growth, it does make provision for brand-name drugs, with the copays varying in each plan.


Medicare plans comprise several details, and you must know exactly what you’re getting. Our Medicare agents in Lancaster PA can help you answer any questions regarding this. Call us at 717-435-8856 to get started.

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