For over 40 years, Medicare beneficiaries paid out of pocket for most of their prescription medications. In 2006, the federal government opened a new program called Medicare Part D to help beneficiaries manage their prescription drug costs.
Medicare Part D is offered via private insurance companies, and you have the ability to comparison shop and choose a plan that best suits your needs.
Medicare Part D is voluntary, meaning you can choose to opt into a plan or not. If you do enroll in Part D, you will be able to access retail prescription drugs at a more affordable rate, and enjoy protection against catastrophic costs in the event you need a very expensive medication.
How much does Medicare Part D cost?
Monthly premiums for Part D coverage vary by plan. In some states, plans can cost as little as $10, and they can go as high as $170 or more in other areas. Premiums are determined in large part by the formulary, or list of prescription drugs covered under the plan.
Medicare does impose an adjusted premium for those with higher incomes. For 2023, if you earn more than $97,000 annually (for individuals) or $194,000 (married filing jointly) then you will owe the Income Monthly Adjusted Amount (IRMAA).
When you purchase prescriptions at the pharmacy, those with Part D coverage will enjoy an affordable co-pay for the medication that your plan administrator negotiated for you. Medications are available in different tiers of pricing, with generic drugs generally being the most affordable.
Finally, you might also be subject to an annual deductible. This is the amount you must pay for your prescription medications before your insurance benefits kick in to cover the rest (except for co-pays). Medicare sets a threshold for deductibles each year, and insurance companies cannot charge more than that limit (although they can charge less). For 2023, the maximum deductible allowed for Part D coverage is $505.
Other notable cost information:
- The initial coverage limit for 2023 is $4,660.
- Coverage gap stage is 25% coinsurance until a person reaches $7,400 TROOP.
- Catastrophic coverage copays are $4.15 for generics and $10.35 for non generic drugs (Or the member pays 5% coinsurance whichever is higher).
Enrolling in Medicare Part D
You are eligible for Medicare Part D when you first become eligible for Medicare (at age 65). You can consult with one of our licensed professionals, who will be happy to explain your plan options, or you can enroll in a Part D plan directly through Medicare. Call 1-800-MEDICARE or visit Medicare’s website for enrollment information.
If you opt for a Medicare Part C (Advantage) plan, Part D coverage might already be rolled into that policy.
Since Part D coverage is offered through private insurance companies with plans that vary, you should carefully consider each plan’s formulary to ensure that your preferred drugs will be available through the plan.
If you don’t enroll in Medicare Part D when you are first eligible for Medicare, you can elect a plan later. Each year, during Medicare’s Annual Election Period from October 15 to December 7, you can add, drop, or change your plan selections.
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