Medicare Part D provides coverage for prescription drugs that are self-administered, meaning those taken at home rather than in a hospital. The base premium for Part D in 2019 is $33.19/month, though additional costs such as co-pays, coinsurance, and a deductible may apply. It’s essential to verify that your medications are covered by the plan you choose.

You may want to delay enrolling in Part D if you already have prescription drug coverage through your employer, spouse’s employer, or the Veteran's Administration. However, without adequate coverage, you’ll face a late enrollment penalty—1% of the premium for each month without coverage. Even if you don’t take prescription drugs now, enrolling early can prevent penalties later.

Each Part D plan offers a formulary, or list of covered drugs, organized by cost tiers. Tier 1 typically includes generic drugs with the lowest copay, while Tier 2 and 3 include brand-name drugs and specialty drugs, which have higher copays.

Part D also covers some vaccines, like the shingles vaccine, but does not cover flu or pneumonia vaccines, which are covered by Part B.

If a drug you rely on is no longer covered, you’ll receive notice and be allowed to switch plans. You can also switch to a covered alternative if available.

While the standard Part D premium is $33.19/month, the amount may vary based on your income and plan. High earners may pay an additional fee, up to $77.40/month for those making over $750,000 annually.

Most plans have a deductible (up to $415/year), but some plans offer lower or no deductible at all. Copayments and coinsurance also apply, based on the drug’s tier. Generic drugs might have a $0-10 copay, while specialty drugs could cost $100 or more. Coinsurance may be up to 25% of the retail drug cost.

Choosing a “preferred” pharmacy in your plan’s network or opting for mail-order services could lower costs.

You can sign up for Medicare Part D during your Initial Enrollment Period (the three months before and after turning 65). There’s also an open enrollment period from Oct. 15 to Dec. 7 each year. Special enrollment periods apply if you lose other creditable coverage or experience certain life events.

Medicare Advantage plans, which may include Part D coverage, can also be enrolled in during the open enrollment period from Jan. to March.

Medicare Part D eligibility is typically for those over 65 or individuals with disabilities who’ve received Social Security Disability Insurance for 24 months. U.S. citizens or permanent residents who’ve lived in the country for at least five years are eligible.

As of 2018, 43 million Americans are enrolled in Part D, with 13 million qualifying for the Low-Income Subsidy.

Part D is particularly helpful for those who take multiple prescriptions, expect future drug needs, or have trouble affording medications. Even with premiums and copays, total costs are typically lower than paying out-of-pocket.

Medication Therapy Management (MTM) services may be available for those on multiple medications, offering personalized support from a pharmacist to manage your prescriptions effectively.

Medicare updates its rules each year. In 2019, notable changes include:

• A $10 increase in the deductible, to $415

• A $70 increase to the initial coverage limit, to $3,820

• A $100 increase to the out-of-pocket threshold, to $5,100

Additionally, shared costs for some brand-name and generic drugs above the initial coverage limit have been reduced. These changes may impact the amount you pay for prescription drugs, so reviewing your plan annually is important.

Consider enrolling in Medicare Part D now to avoid late penalties. If you need assistance finding the right plan for you, contact Matt Ryan Agency. Our licensed agents are ready to answer your questions and help you select a plan that fits your needs.