Medicare Part D Frequently Asked Questions

What is covered under Medicare Part D?

Medicare Part D covers the drugs you take on your own, that is, outside of the doctor’s office.

Beyond legal minimum coverage requirements, plans vary widely in their coverages, costs, and formularies. Approximately 20 different Part D plans are offered in New York.

Part D does not cover over the counter medications or prescription vitamins.

Who can get a Part D Plan?

If you qualify for Medicare, you qualify for a Part D plan. You may not be denied due to your health status.

What does a Part D plan cost?

Part D enrollees pay both a premium and co-pays for their prescription drugs.

The total premium for Part D varies between plans and changes each calendar year. Part D premiums have averaged around $30 per month per individual since 2009.

Your income may affect your Part D premium. If you are an individual earning over $85,000 per year or couple earning over $170,000 per year, you may incur higher premiums in the form of a Medicare surcharge.

Your premiums may also be influenced by when you sign up. If you are not covered by drug coverage considered as good as Medicare and fail to sign up for Part D when you become eligible for Medicare, your premiums may be higher.

Co-pays vary by plan and prescription. When selecting a plan, you need to understand how each of your currently prescribed drugs fits into the plan’s coverage to determine your out of pocket drug costs.

What is the doughnut hole?

Part D plans have an annual deductible, which must be met before coverage begins. During this time, individuals pay a price negotiated by their plan with the drug manufacturer.

Once your deductible is met, you then begin your initial coverage period. During your initial coverage period, you pay a portion of your drug costs until costs reach a level set by law, known as the catastrophic level of coverage. Once catastrophic level is reached, covered individuals pay no more than approximately 5% of the costs of prescription drugs. The gap between the initial coverage period and catastrophic level of coverage is known as the “doughnut hole.”

What is the Open Enrollment Period?

The open enrollment period is the time of year that you may elect to change your Part D plan.

When is the Open Enrollment Period?

The Open Enrollment Period takes place between October 15th and December 7th each year.

What is a Part D formulary?

A formulary is the specific set of drugs covered by each Part D plan. No Part D plan covers all prescription drugs. Certain drugs are excluded from Medicare by law.

You should review the formularies of the Part D plans you are considering ensuring that your prescriptions, or a doctor-approved alternative, are included in the formulary. In some instances, you may apply for an exception for your plan to cover a needed drug that is not in your plan’s formulary.

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