Medicare Part D

Medicare prescription drug plans are called Part D of Medicare. Health insurance companies contract with Medicare to supply Part D prescription drug plans. Medicare does not have their own prescription drug plan.

Stand-alone Part D plans require a monthly premium, sometimes a deductible, and co-pays for the owner to pay when they get a prescription.

Part D coverage can also be included in Medicare Advantage Plans or the "all in one plans" at no extra cost. Prescriptions are divided up into five different tiers or groups of prescriptions. They are:

• preferred generic,

• generic,

• preferred name brands,

• non-preferred name brand,

• and specialty drugs.

Co-pays will vary depending on what tier the drug falls into according to the insurance companies formula or drug list.

In 2020, if you reach $4,020 of total prescription cost including what you and your insurance company have paid for those prescriptions, you fall into what is called the "coverage gap." It is also known as the "doughnut hole." At that time your co-pay would increase and remain higher until the end of the year or until you have paid $6,350 out of pocket for the year. If you were to spend that much, you would fall into the "catastrophic coverage level" and your co-pay would be reduced to only 5% of the retail price for the rest of the year. Once the year has ended everything starts all over again.

If you have any questions on finding the right prescription drug plan for yourself, please call us. We are always ready to be your problem solver!