Medicare Part D is the drug coverage regulated and approved by Medicare, but offered by insurance companies. Each plan varies not only in monthly cost, but also in drug coverage. Thus, it is important not to base your enrollment on just the monthly cost of the plan. We will take into consideration your monthly premium, your annual deductible (if there is one), and your annual drug cost to make sure you are getting the best overall coverage for the year.

There are two ways to enroll in a Part D Plan:

A stand-alone Medicare Part D Plan (PDP).

A Medicare Advantage plan that includes drug coverage (MAPD).

To get a quick and free quote for a Medicare Part D Plan, please give us a call at 702-688-3083 and have your list of medications ready.

Donut Hole (Coverage Gap)

The most confusing and frustrating part of Medicare is the dreaded Donut Hole (officially known as the Coverage Gap). The bad news is that it generally makes the cost of your prescriptions go up.

Medicare can only give a certain amount of drug coverage for each person, so once your full cost (combination of what you pay and the insurance company pays) reaches $4,020, you will go into the coverage gap where you would pay 25% of the cost of both brand name medication and generic medication.Once you reach $6,350 out-of-pocket, you will get out of the Coverage Gap and reach Catastrophic coverage and the costs of your medications will drop significantly to just 5% or $3.35 for generics and $8.35 for brand-name drugs, whichever is greater.

To find out more about the Coverage Gap and Catastrophic Coverage, please visit the Medicare.gov website.

Late Enrollment Penalty

Choosing not to enroll in Medicare Drug coverage when you are first eligible could lead to a late enrollment penalty. The penalty does not apply if you had other creditable drug coverage (such as employer/union coverage, VA benefits) or if you get Extra Help.

The late enrollment penalty is 1% of the average cost of a Medicare Part D plan. That average is about $32.74, which would be around $.30. That small penalty accumulates for the number of months you go without drug coverage. Once you do enroll in a drug plan, that extra penalty is added on to your monthly cost. For example, if you go two years without drug coverage and then enroll in a plan, Medicare would add on about $7.20 a month to the cost of your drug plan.

Extra Help

You may qualify for very little to zero premium and co-pays on your prescription plans if you meet certain income and resource qualifications. You may qualify if your previous years income was below $18,735 if you’re single ($25,365 for married) and your resources add up to $14,390 if you’re single ($28,720 for married).

Resources that count are money in a checking or savings account, stocks, and bonds. Resources that don’t count are your home, one car, burial plot, furniture and other household and personal products.

If you’re on Medicaid or other state programs, you may automatically qualify for Extra Help.

To find out more about Extra Help and to see if you qualify, fill out an application with Social Security.

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If you have any other questions, feel free to contact us at 702.688-3083 or schedule your free consultation with our expert!