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Medicare Part D

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Medicare Part D 

Medicare Part D is a prescription drug benefit program that is offered as part of the broader Medicare federal health insurance program for persons 65 years and older, certain younger people with disabilities, and people with end-stage renal disease. Part D is an optional benefit that is administered by private insurance companies and available to anyone who has Medicare.

What is Medicare Part D (Prescription Drug Benefit)?

Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage prescription drug plan (MA-PD), mainly HMOs and PPOs, that cover all Medicare benefits including drugs. In 2020, 46 million of the more than 60 million people covered by Medicare are enrolled in Part D plans.

How does Medicare Part D work?

Medicare offers two ways to get prescription drug coverage—Part D and Medicare Advantage. Medicare Part D is one component of the overall Medicare program, which is a national health insurance program.

While Medicare extends to a wide variety of medical treatments, Part D is focused specifically on making drug prices more affordable for Americans 65 years and older.

People already covered by Medicare generally can opt in to Medicare Part D. If you do, you will be charged the same kinds of costs found with standard insurance plans, such as monthly premiums, annual deductibles, and various copays. In exchange, you get additional coverage for prescription drugs as compared to what is already offered by the broader Medicare program. For this reason, it’s up to you to choose whether subscribing to Medicare Part D makes economic sense, given your health needs and financial circumstances.

How much does Medicare Part D cost?

You’ll make these payments throughout the year in a Medicare drug plan:

  • Premium
  • Yearly deductible
  • Copayments or coinsurance
  • Costs in the coverage gap
  • Costs if you get Extra Help
  • Costs if you pay a late enrollment penalty

Your actual drug coverage costs will vary depending on:

Your prescriptions and whether they’re on your plan’s list of covered drugs  (formulary).

  • What “tier” the drug is in.
  • Which drug benefit phase you’re in (like whether you’ve met your deductible or if you’re in the catastrophic coverage phase).
  • Which pharmacy you use (whether it offers preferred or standard cost-sharing, is out of network, or is mail order). Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less.
  • Whether you get extra help paying your drug coverage costs.

2025 Part D Details

The Part D RX coverage is subject to many changes for 2025.
Reviewing Part D during open enrollment – 10/15 – 12/7 - could be very important to you.
 
Medicare is changing regulations on how we can help people enroll in Part D.  We want to be as helpful as possible in your understanding your Part D options while staying on the right side of these new regulations.
What is the saying????  The only constant is change.
 
Also, before we talk about Part D during open enrollment, please set up Medicare.gov accounts for each of you.
If you do on your own, the below will can get all your 2025 Part D options to evaluate.
 
Having an account online is the only way to save your info. and update, for later review.  (You can check Part D costs without an account**with no option to save your details, see below).
The Medicare site will give your costs for each plan available.  Variables are your prescriptions, pharmacy used,
deductible, plan premium.  Prescriptions are tiered to establish copays, formularies are the lists of drugs covered by each plan and at what tier.  You will be able to shop all plans here, looking at the variables that are important to you.
 
*To set up Medicare.gov account online:
The Medicare website changes often, and hopefully is intuitive.  This is current path to create account.  You may have to tweak as Medicare changes their site.
  1. In browser go to www.Medicare.gov
  2. Upper right, go to login
  3. Go to create account
  4. Follow prompts
Once you have account, you can log in and the below ** path #1-10 will get you where you need to go.  Or:
  1. After logged in, go to Open all Options
  2. Update my saved drugs
  3. Confirm pharmacy
  4. Start
  5. Check box you are not getting any extra help (bottom)
  6. Hit Find plans now
  7. Check Part D plan – not Medicare Advantage, or supplement
  8. Typically as we roll into open enrollment, there will be a toggle to check 2024 or 2025 plans.  Please double check you are in the correct year.  When you get to the step where you are looking at listing of all plans, it will say 2024 or 2025.
  9. Hit Find plans now
  10. See drug costs
  11. Confirm
  12. Hit done
 
**If you do not want to set up a Medicare account online, however you do want to check all Part D plans in your area, this is way to check anonymously:
     1.  Go to www.Medicare.gov
     2.  Go to “Find Health & Drug Plans”
     3.  Enter your zip code
     4.  Enter you want to look at Part D plans
     5.  Check the box that you do not get any extra help.
     6.  Highlight yes that you want to see drug costs
     7.  You can enter your prescriptions and pharmacy next. 
8. Typically as we roll into open enrollment, there will be a toggle to check 2024 or 2025 plans.  Please double check you are in the correct year.  When you get to the step where you are looking at listing of all plans, it will say 2024 or 2025.
     9.  Hit next to get personalized details and costs of plans available in your zip code – on right side towards middle to top of all plan details, confirm you are sorting by lowest drug & premium cost.
   10.  The Medicare site will give your costs for each plan available.  Variables are your prescriptions, pharmacy used, deductible, plan premium.  Prescriptions are tiered to establish copays, formularies are the lists of drugs covered by each plan and at what tier. 2024 will display.  We will look at 2025 when we talk.
 
Once you choose a plan, please enroll.  You can do this on Medicare.gov*, or call Medicare, 1-800-633-4227 –  Typically Medicare asks you to enroll on their website….it is relatively intuitive.  One helpful note, when they ask what your enrollment period is, it is Annual enrollment if 10/15 – 12/7, losing employer coverage if dropping employer coverage after age 65, or new to Medicare if just turning 65.
Annual Enrollment - Please enroll before 12/7. You can call me to review before enrolling.

Online Part D Class

Our screen share for 2025 Part D enrollment is offered, Tuesday 10/1 at 4pm. and Saturday 10/5, 3pm.  More classes if enough interest.
 
Going forward, the help we will be able to offer you with Part D is changing.  You will have homework before we talk, get together, or you assess your options on your own.
Please use this link on your computer to join our meeting  https://meet.goto.com/julie3
You will “Join Browser”, you do not need to download app.
No to camera access.
Yes to microphone on.
I believe in lower right you can raise hand for questions, if I need to mute from my end.

Already have Medicare Part D ? Switching is easy

It might be time to switch insurers whenever the service that your existing insurer provides doesn’t meet your needs. For example, if you have a poor claims experience or an unexplained rate increase, it might be time to consider other options

If you cancel a previous policy before a new policy is effective, you could run into some serious financial problems.

Contact us today to help you with multiple options to choose from.
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