What Does Medicare Part D Cover?
All Medicare Part D plans are required to cover a wide range of medications, including most drugs in certain protected classes like drugs to treat HIV/AIDS or cancer.
Each plan comes with its own formulary, a list of covered drugs. Most plans put drugs in different levels, or tiers, on their formularies. A drug’s cost depends on the drug’s tier, with drugs in lower tiers typically costing less than drugs in higher tiers.
Plans include generic and brand-name drug coverage and the formulary is required to include coverage for at least two drugs in each class. The formulary might not include the specific drug you take, but usually, it will include a similar drug. If your prescriber doesn’t think a similar drug listed on your plan’s formulary is a good substitute, you can ask for an exception.
Drug plans are allowed to make changes to their formularies, but your plan will notify you if any changes are made. With this in mind, you always have the option to change to a different Part D plan during the annual election period between October 15th and December 7th each year.
How Much Does Medicare Part D Cost?
Costs for Medicare Part D include:
- Monthly premium. Every premium for Part D will vary by plan, but the national average is $33.06.
- Yearly deductible. Deductibles also vary between plans, and some plans don’t have a deductible. In 2021, no Part D plan may have a deductible greater than $445.
- Coinsurance or copayments. Once you and your plan spend $4,130 combined on drugs (including your deductible), you won’t pay more than 25% of the cost for prescription drugs until your out-of-pocket spending reaches $6,550.
How much you pay for drug coverage will depend on your medications and whether they’re on your plan’s formulary, the tier your drugs are in, which drug benefit phase you’re in, the pharmacy you use, and whether you get Extra Help paying your prescription costs.
Not Sure If Medicare Part D Is Right For You?
At Caring Insurance Solutions, we can use our research and experience to help you find the best possible drug coverage for the price that fits your budget. Contact us today at email@example.com or 405-694-0892.
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