8 Frequently Asked Questions: Medicare Part D

Medicare Part D might just be one of the most complicated aspects of the Medicare program. Almost everyone has access to a wide range of plans, making it difficult to pick the best Part D plan for you. Plus, each Part D plan has four different coverage phases. Your costs for prescriptions vary within each phase, so it is sometimes hard to budget your prescriptions from month to month.

1. What is Medicare Part D?

Medicare Part D consists of prescription drug coverage plans that are available to people with Medicare. They can be purchased as a stand-alone plan, or are sometimes included as part of a Medicare Advantage (Part C) plan.

2. Who is eligible for Medicare Part D?

Individuals who are 65 years of age or older, people with certain disabilities, and those with End-Stage Renal Disease are eligible for Medicare Part D. You must be enrolled in one or both parts of Medicare (Parts A and B) to apply for a Part D plan. In addition, you can only enroll in the Part D plans available in your service area.

3. How much does Medicare Part D cost?

The cost of Medicare Part D varies depending on the specific plan you choose. It usually includes a monthly premium, an annual deductible, copays or coinsurance, and a coverage gap (also known as the "donut hole"). If you earn a high income, you’ll pay an additional fee called IRMAA, the Income Related Monthly Adjustment Amount. IRMAA thresholds and amounts change each year.

4. What is the coverage gap in Medicare Part D?

The coverage gap in Medicare Part D occurs when the total amount you and your plan have spent on covered drugs reaches a certain limit. During this time, you may have to pay more out-of-pocket for your prescription drugs. When you’ve spent a certain amount, you’ll enter catastrophic coverage and will pay less for medications.

5. How do I enroll in Medicare Part D?

You can enroll in Medicare Part D during the Initial Enrollment Period when you first become eligible for Medicare or during the Annual Enrollment Period (October 15 - December 7). If you have certain life events - like moving to a new state - you will also be eligible for a Special Enrollment Period, which allows you to change your Part D plan when the event occurs. You can enroll yourself online, by phone, or in person at a Social Security office. Or, you can use the help of a local Medicare advisor, who will ensure you pick the Part D plan that best fits your needs.

6. What happens if I don't enroll in Medicare Part D when I am first eligible?

If you do not enroll in Medicare Part D when you are first eligible, you may face a penalty fee. Even if you are not taking any prescriptions, it’s important to enroll in Part D to avoid these penalties. Fortunately, there are very low-cost plans you can choose.

7. Can I change my Medicare Part D plan during the year?

Yes, you can change your Medicare Part D plan during the Annual Enrollment Period (October 15 - December 7) or during a Special Enrollment Period if you have a change in circumstances, such as moving to a new coverage area. However, once enrolled, you will not be able to change your plan mid-year unless you qualify for an SEP.

8. What if I have other drug coverage, such as through an employer?

If you have other drug coverage, you should compare it to Medicare Part D to determine which plan provides better coverage for you. You may still choose to enroll in Medicare Part D even if you have other drug coverage. If you still want to delay Part D, make sure your existing prescription plan is creditable for Medicare. Doing so will ensure you don’t pay the late enrollment penalty.

Local Medicare Specialists are a qualified team of independent insurance agents. Our advisors are experts in all parts of Medicare and understand your local market. Chat with an agent if you need to enroll in Medicare, want to review your current plans, or just have questions. We are here to help!