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Medicare Part D helps pay for outpatient prescription drugs. You have to choose a prescription drug plan in your area to receive Part D benefits.  In most cases, you will be required to use only the plan’s network pharmacies in order to receive full plan benefits and you may be limited to a formulary, which is a list of specific drugs covered by the plan you choose.  Not all drugs are covered by all plans.

The pharmacies in the plan’s network and the drugs included in their formulary can change periodically.  If the formulary or pharmacy network changes, you will receive a notice from your Part D plan administrator.

Private companies administer Part D.  These companies, called Carriers, receive funding from the Federal Government to administer the plans.

Enrollment in Part D is optional and voluntary.  No one is required to participate.  You can enroll in Part D anytime during your Initial Enrollment Period.  Your Part D Initial Enrollment Period coincides with your Part B Initial Enrollment Period. It begins three (3) months before the month you turn age 65 and ends three (3) months after the month you turn 65.  For early Medicare beneficiaries, the enrollment period coincides with your Part B enrollment.

NOTE: If you miss your Initial Enrollment Period, there are two (2) subsequent Periods:

You may also change your Part D plan each year during the Annual Election Period.

You can enroll in Medicare Part D by going to Medicare’s website.  There you can see a comparison of different plans, including formularies, costs, and other important information.  

If you would prefer, you can email me a list of your prescriptions, and I will do the research and send you a report.  Please send the following information with the request:  prescription (whether it is generic or brand name/and if it is brand name, indicate if a generic is acceptable), dosage, frequency (how many per day), your zip code, and preferred local pharmacy.  You should also include your phone number.  If I have a question about your inquiry, I would prefer to contact you by phone.

There is a premium for Part D coverage, which most beneficiaries must pay.  The premium amount is set by the providers, but it is also indexed to your income.  For example, if you are single, and make more than $85,000 ($170,000 for couples), your premium will be higher.

Conversely, those who have limited assets and incomes below a certain level—may be eligible for assistance with their Part D premiums, deductibles, and co-pays.  Requirements for low income assistance vary by state and can change annually.  To find out if you are eligible, contact the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778).

Depending on the benefit design of the plan you choose, there can be annual deductibles, coverage gaps, co-payments and/or coinsurance amounts.  You must pay all deductibles, coverage gaps, co-payments and/or coinsurance amounts out of your pocket.  These amounts can change annually.

Different carriers administer the program in different ways.

Most Medicare Prescription Drug Plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2014, once you and your plan have spent $2,850 on covered drugs (the combined amount plus your deductible), you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Once you reach the coverage gap in 2015, you'll pay 45% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.

Although you'll only pay 45% of the price for the brand-name drug, the entire price (including the discount the drug company pays) will count as out-of-pocket costs which will help you get out of the coverage gap.  

In 2015, Medicare will pay 35% of the price for generic drugs during the coverage gap. You'll pay the remaining 65% of the price. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.

What you pay for brand-name and generic drugs will decrease each year until it reaches 25% in 2020.

Once you've spent $4,700 out-of-pocket for 2015, you're out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get "catastrophic coverage." It assures you only pay a small coinsurance amount or co-payment for covered drugs for the rest of the year.

Medicare Part D 2016