Medicare Part D Coverage

In this 2019 Part D Prescription Drug Guide, you will discover important details you need to know about Part D Plans!

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Maybe you’ve heard some information about Medicare Part D from friends and family but what exactly is Part D anyway & how does it fit within Medicare Insurance benefits? We consolidated & simplified all the important details for you by answering common questions to help save you time, money and energy!

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2019 Medigap Plan

Last Updated: 10/1/2019

What is a Medicare Part D?

Medicare Part D is optional, private drug coverage for seniors 65yrs.+ who are on Original Medicare not Medicare Advantage. Part D works in conjunction with Medicare Part A, B & Medigap Plans. Although Part D & Plan D sound similar they are not the same thing! Plans and Parts work differently within Medicare Insurance (more below). Another source of confusion is between Part D Drug Plans (PDP) & Medicare Advantage Drug Plans (MA-PD) both operate off seperate programs. Part D has its own enrollment period and does carry a penalty if you sign up late! The most important factors for Part D plans come down to drug availability (do they carry what you need or have a substitute?), location, location, location (Do you have to drive far away to fill your prescriptions?) & of course cost.

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What does Medicare Part D drug plans cover?

Medicare Part D drug plans cover seniors 65yrs+ enrolled in Original Medicare not Medicare Advantage. Private drug plans must provide a set standard level of drug coverage by Medicare (ie: the Government). Plans consist of a formulary. Formularies are lists of grouped prescription drugs which are organized into different tiers based on drug types (branded or generic) and price. Furthermore, formularies must cover at least 2 common drugs, per drug category and/or class. Drugs and formularies can change due to new or discontinued drugs but it must be approved by Medicare first. If a drug you are taking changes, you will be given a 30 day notice by your plan carrier. In some cases, you may be required to change drugs or pay a higher price.

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What does Medicare Plan D not cover?

Medicare Part D coverage may not include a specific drug but a substitute drug is most likely available in each drug category or tier. You will need to evaluate a drug plans formularies. If your health care provider does not agree with a drug, you can make an exception. As mentioned, plan providers can change your drugs at any time but do give a 30-day advance notice.

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How do I compare Medicare Part D drug plans?

Comparing Medicare Part D drug coverage can be time consuming doing it alone. With Bridge, we save you time with our personal, concierge service by helping you compare drug plans in your location while finding alternatives with plan sign up. Simplify the process by speaking with a Bridge Agent who can answer your questions & run all your drug plan comparisons for you at no cost!

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Am I eligible for Medicare Part D drug coverage?

In order to be eligible for Medicare Part D drug coverage one must;

  • Be age 64 1/2 or older;
  • Be a U.S. resident; AND
  • Be either a U.S. citizen, OR
  • Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.
  • Enrolled in Medicare Part A
  • Enrolled in Medicare Part B or given an Effective Date.
  • Not be enrolled on Medicare Advantage.

If one meets the criteria above, they can enroll in Medicare Part D.

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How do I enroll in Medicare Part D drug coverage?

Once you meet the Part D eligibility requirements above, enrollment is pretty simple. We suggest compiling a list of all your current prescription drugs and then comparing Medicare Part D drug coverage in your local area by either doing the work yourself and sign up through Medicare.gov or contacting a Bridge Customer Care Agent who will help you compare brands and prices!

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How does Medicare Part D drug coverage work with a Critical Illness Insurance for cancer, heart-attack & stroke coverage (CHAS)?

Part D is compatible with CHAS insurance / cancer plans however since they are considered standalone plans, they would need to be purchased separately. By working with a Bridge Agent, we can help you find an CHAS and/or affordable critical illness insurance plans to fit your needs.

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What is the Medicare Part D penalty fee?

If you enroll in a Medicare Part D 63 days or more past your Initial Enrollment Period (EIP), you may pay an increased monthly drug costs. Here is the 2019 Part D Late Enrollment Penalty cost “Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may increase each year, so your Part D penalty amount may also increase each year”.

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How does Medicare Part D work with a Long Term Care Insurance (LTC)?

Medicare Part D is compatible with LTC plans however, since they are considered standalone plans, they would need to be purchased separately. There is talk about developing a new Medigap plan to include LTC coverage. By working with a Bridge Agent, we can help you find an affordable LTC insurance plan to fit your needs(LTC).

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What is the difference between generic and brand name drugs?

Generic and brand name drugs differ in quality or process. However, generic drugs must contain the same active ingredients as branded drugs and prove to the FDA that the generic version works in the same way. Always talk to you doctor or prescriber first before switching medications.

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How does Medicare Part D work with a Health Savings Account (HSA)?

Medicare Part D is considered a qualified expense to pay out of your Health Savings Account (HSA). An HSA can pay for Medicare Parts A, B, C & D. Once enrolled in Medicare, enrollees are no longer able to contribute to their Health Savings Account. However, the funds can be used to pay for qualified Medicare costs stated above. If one postpones Medicare enrollment they may still contribute to their Health Savings but enrolling late will also be subject to a Medicare Late Enrollment Penalty which is a percentage increase of costs per year. Speak with your Financial Advisor to determine what works best for you!

What are the Medicare Part D prescription drug tiers?

Drugs are organized into tiers based on cost. Generally lower tier drugs cost less than higher tier drugs. Here are some examples of drug tiers though yours may differ depending on the drug plan you choose.

  • Tier 1—lowest copayment : most generic prescription drugs.
  • Tier 2—medium copayment: preferred, brand-name prescription drugs
  • Tier 3—higher copayment: non-preferred, brand-name prescription drugs
  • Specialty tier—highest copayment: very high cost prescription drugs

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Do I need Medicare Part D?

If you are on Original Medicare and over the age of 65, we suggest obtaining a Part D prescription drug plan because otherwise you pay a penalty (stated above). Plus, prices are reasonable depending on the drugs you take. A Bridge Customer Care Agent can help you answer questions and find the right Part D Drug Plan to fit your needs.

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2019 Medigap Guide

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How much does a Medicare Part D drug plan cost?

Since Part D drug plans vary in price, availability and carrier, we suggest you contact a Bridge Agent to get a free, no-obligation comparison quote.

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How do I pay for Medicare Part D?

Paying for a Medicare Part D prescription drug plan can be setup through your plan provider through auto bank drafts from these potential sources, checking account, social security funds, health savings accounts or other qualified means. We suggest auto-draft to avoid lapsing your policy!

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How does Medicare Part D work with my other insurance?

If you have Union coverage, they will notify you (keep record). For COBRA, it’s probably best to enroll when you can but you may be eligible for a special enrollment once COBRA ends. For Medigap Plans, Part D plans work great together! You can find out more about how Part D and other insurance work together by visiting Medicare.gov. Did you know? By working with a Bridge Customer Care Agent, we can help you find affordable Part D drug plans to fit your needs!

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In Conclusion

There are two types of drug plans. One type works with Original Medicare called PDP or Prescription Drug Plans that work great with Medigap Plans. Another type is called a Medicare Advantage Drug Plan called MA-PDP. Both options are managed by private drug carriers who work with Medicare. Drug plans are federally approved to include most drugs or alternatives between name brand and generic options. One should check the plan’s formulary to ensure drugs are covered or speak with their Doctor. If you need assistance in a drug plan, contact Bridge today!

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