Medicare: Part D

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Also called the Medicare prescription drug benefit, this is is an optional add-on

to your Medicare benefits. It is to to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

What does it cost?

The costs will vary depending on:

The drugs you use
The plan you choose
Whether you go to a pharmacy in your plan’s network
Whether the drugs you use are on your plan’s formulary
Whether you get Extra Help paying your Medicare Part D costs

Most Medicare Prescription Drug Plans charge a monthly fee that varies by plan. You pay this in addition to the Medicare Part B premium. If you join a Medicare Advantage Plan (Part C) or Medicare Cost Plan that includes Medicare prescription drug coverage, the plan’s monthly premium may include an amount for drug coverage.

Since the cost has so many variables, You would need to list your prescriptions against the costs of the programs to see if this plan is necessary. For instance, I have three prescriptions that would cost me about $75.00 per month. The plan is more than that for me, so I am going to pass for now. However, if I needed some antibiotics or whatever, I’d have to pay out of pocket for those.

What does it do?

Covers the cost of prescription drugs that you are taking or might need to take.

However, Medicare drug plans may have these coverage rules:
Prior authorization: You and/or your prescriber must contact the drug plan before you can fill certain prescriptions. Your prescriber may need to show that the drug is medically necessary for the plan to cover it.
Quantity limits: Limits on how much medication you can get at a time.
Step therapy: You must try one or more similar, lower cost drugs before the plan will cover the prescribed drug.

Vaccines: Except for vaccines covered under Medicare Part B (Medical Insurance), Medicare drug plans must cover all commercially available vaccines (like the shingles vaccine) when medically necessary to prevent illness.

The prescription drugs you get in a hospital outpatient setting, like an emergency department or during observation services, might not be covered by Part B. These are sometimes called “self-administered drugs” that you would normally take on your own. Your Medicare drug plan may cover these drugs under certain circumstances. You might need to pay for these yourself, then fill out a claim with you drug plan to be reimbursed.


How do I get it?

Individuals on Medicare are eligible for prescription drug coverage under a Part D plan if they are signed up for benefits under Medicare Part A and/or Part B. You can sign up via the Social Security Program Social Security website or through a 3rd party Medicare Advantage Program.

Some of the information in this article was gleaned from