What is Medicare Part D?

About Medicare Part D

Medicare Part D is a federal prescription drug plan administered through private insurance companies. Medicare beneficiaries can enroll in a standalone Part D drug plan that either supplements their Original Medicare or they can choose a Medicare Advantage plan that also features prescription drug coverage

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What is Medicare Part D?

A Part D plan is insurance for necessary prescription medication. You pay a monthly premium to an insurance company for your Part D plan. There is a copay or percentage cost to you, but the insurance company will pay for part of your prescription medication.

You will receive a separate Part D insurance card that is separate from your other Medicare-related cards.

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How does Medicare Part D work?

Here is important information you need to know about owning a prescription drug plan:

  • Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $445 in 2021. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
  • Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2021, the initial coverage cap is $4,130. After you and the insurance company together have paid this amount, then you enter the coverage gap.
  • The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $6,550 out of your own pocket in 2021.
  • Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.
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How to enroll in a Prescription Drug Plan

If you are enrolled in Original Medicare, you are eligible for Medicare Part D. If you are interested in getting help paying for your prescription drugs, talk to a licensed Medicare specialist at RAIMA Insurance today!

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