These policies help cover prescription drug costs. You can sign up for Part D Prescription Drug Coverage 3 months before your 65th birthday. If you do not enroll by 3 months after your 65th birthday, you will get a late enrollment penalty that you must pay every month for the duration of your drug coverage.  If you work passed your birthday and have credible coverage, you will not incur the late penalty, but you must enroll within 63 days of losing the credible coverage to avoid a penalty at that time.  The late enrollment penalty is calculated by taking 1% times the national average premium times the number of months you did not have coverage.

If you are already in a Part D stand-alone drug plan or a Medicare Advantage plan that includes drug coverage, you can switch plans during the annual enrollment period from Oct 15-Dec 7th each year.

How Does It Work?

Each year the drug coverage rules change, but they are based on the true out pocket cost or actual retail cost of the medicines. There are 4 stages:

  • Deductible Stage- presently, during the deductible stage, if your plan has a deductible, you will pay the first $505 (2023) then move to the Initial Coverage Phase
  • Initial Coverage Phase-presently, you pay copays until the retail cost gets up to $4660
  • Coverage Gap (Donut Hole) Phase- then in the coverage gap phase, you will pay 25% of all medicines until your retail cost gets up to $7400
  • Catastrophic Coverage Phase- finally in this stage, you will pay whichever is greater, either 5% of the total drug cost or $4.15 for each generic and $10.35 for each brand name drug

How to choose a plan

It is vital to review your Part D coverage every year, especially if you are taking any new medicines.

You can start by looking on   Enter your medicines and pharmacies to see all the plan options.  You can see the monthly costs for each medicine and the differences in pharmacy.

Each plan has a preferred, standard, or out of network pharmacy. Most plans have a mail order option as well. They can vary drastically from plan to plan.

Contact us to check your medications for you, to make sure you are on the best suited plan and explain any details you do not understand. Then let us do the enrollment for you.

Individuals with low annual incomes may qualify for Extra Help from Medicare.  Extra help helps pay your Part D premiums and out of pocket drug costs. Enroll using this link.