According to the Centers for Medicare & Medicaid Services (CMS), approximately 70% of Medicare beneficiaries are enrolled in Part D. That’s a big percentage, and, chances are, you may be a part of it—but is it really right for you? Here are a few things to consider before you enroll in Medicare Part D.
What is Medicare Part D?
Medicare Part D is an additional plan you can include with your Original or Advantage Medicare coverage. Generally speaking, it provides cost coverage for a variety of prescription drugs.
Although specific premiums and drug availability will depend on the area you live and the provider you choose, copayments and coinsurance fees will remain relatively the same across the board. “Generic” drugs cost less than brand-name drugs but with the same quality. The same can be said for drugs that are “preferred” by your plan versus non-preferred.
The Coverage of a Part D Plan—Do You Need it?
Even though Part D is an excellent option for many people and offers great coverage, that still does not mean that it is right for everyone.
If you are simply not concerned about your need for prescription drugs or your ability to afford them if you do, you may not need Part D. This is especially applicable to anyone who earned a higher income within the past two years.
This is referred to as the Income Related Monthly Adjustment Amount (IRMAA), and it is based on your tax filings. If you earned less than $88,000 on your own or $176,000 with a spouse, you will pay your plan’s normal premium. If, however, you make more than this, you will have a $12.30 to $77.10 additional fee added to your Part D plan. If you are wealthy enough to fall within this bracket, you may feel confident in avoiding this fee altogether and just paying out-of-pocket.
This, however, is not realistic to many people. If you fall on the other end of the spectrum and are worried about paying for Part D in the first place, you may qualify for the Extra Help program to cover some of its costs.
With this in mind, you should always consider having more coverage, even if it is with a Part D plan. This is because you never know what emergencies may pop up, leaving you in a stressful financial situation. If this situation has anything to do with you and your health, this may mean taking prescriptions are involved, and as we all know, this can lead to hundreds of dollars out-of-pocket without the proper coverage.
Now, before you get a Part D plan, it is important to know what specific drugs it will cover. Do keep in mind that not every plan is the same or covers the same exact prescriptions. To find one that meets your needs the best, you can give us a call and we’ll help you compare plans in your area to determine if its coverage matches what you need.
With that being said, there are some requirements that all Part D prescription drug plans must meet when it comes to providing coverage. For example, every Part D plan is required to cover at least two prescription drugs from every class. They are also required to cover most, if not all of these specific drugs:
- Antipsychotics
- Anticonvulsants
- Antidepressants
- Anticancer
- Immunosuppressants
- HIV/AIDS drugs
There are also some drugs these plans are not allowed to cover, which include:
- Weight loss or weight gain drugs
- Over-the-counter medication
- Fertility medication
- Erectile dysfunction medication
- Cosmetic drugs
Your Options Without Part D
Without a standalone Part D plan, you can seek out prescription drug coverage through an Advantage plan. Many Medicare Advantage plans provide Part D coverage.
With Original Medicare alone, you will have extremely limited drug coverage—it’s not something you can rely on to meet a full scope of prescription needs.
If you purchase a Medicare Supplement plan, keep in mind that these plans are only designed to supplement your Original Medicare coverage. They will not provide prescription drug coverage. Fortunately, you’ll be able to add on a standalone Part D plan even if you do have a Medicare Supplement plan.
Get Your Medicare Questions Answered with MB Insurance Solutions—Call Today
Still not sure if Medicare Part D is right for you? Curious about your other options? MB Insurance Solutions can help—call us today at 813-767-2878.