What Does Medicare Part D Cover?

Medicare Part D is the prescription drug component of Medicare. This is sold through private insurance, which is why its costs can vary between policies. Medicare Part D can make a major difference in prescription savings.

What makes Medicare Part D different?

Aside from certain Medicare Advantage plans, no other Medicare policy covers prescription drugs. This is where it sets itself apart, and it can make a tremendous difference in what you pay at the pharmacy.

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What prescriptions does it cover?

Not all Part D plans cover the same prescriptions. Each has its own formulary or list of prescriptions. That being said, formularies must cover at least two medications in each drug class listed. All must provide coverage for protected classes. Protected classes are medications that make the difference between life and death, such as those for treating cancer.

Medications that are not covered tend to be over-the-counter drugs and those used for cosmetic reasons such as weight loss.

How does Part D help save on costs?

Medicare Part D’s formulary splits medications into tiers:

  • Tier 1 - Generic
  • Tier 2 - Brand-name (preferred)
  • Tier 3 - Brand-name (not preferred)
  • Specialty tier - highest costs

Tiers are in order from least to most expensive. When you join, your insurer will try to find you a generic version of your medication. If there is not a generic version, then your plan will help you find a similar medication in a lower tier.

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When so I join

There are a few times you can join a Medicare Part D plan:

  • Initial Enrollment Period - this takes place during the month of your 65th birthday, as well as the three months before it and the three months after it
  • Annual Enrollment Period - October 15 through December 7. You can switch, drop, or change Part D plans during this period.
  • Special Enrollment Period - you can join without late fees if you had other creditable prescription drug coverage. If you lose your prescription drug coverage, you have up to 62 days to join a drug plan without late fees.

Late fees accrue 1% per month you have gone without joining after the Initial Enrollment Period is over, or, after you go at least 63 days in a row without other creditable prescription drug coverage. This percentage is multiplied by your premium, that number is rounded to the nearest dime, and that is the additional amount you will pay on top of your monthly premium. This lasts throughout the remainder of your time holding the policy. This is why it’s important to join in a timely manner.

Prescription drug savings have never been easier

Heritage First brings you the opportunity to join a prescription drug plan that can cut your costs significantly, erasing the stress of paying top-dollar for the medications you need. We’re here to get you on board with a Part D plan. Call us today at 816-931-0375 or schedule an appointment with us on our website.

Or give us a call at 816-931-0375