Medicare Part D - Prescription Drugs

Medicare Part D is prescription drug coverage available to anyone with Medicare Part A and/or Part B. It helps cover the cost of prescription medications, offering a variety of plans with different levels of coverage.

Medicare Part D is offered by private insurance companies approved by Medicare. It can be obtained in two ways:

1. Stand-Alone Prescription Drug Plans (PDPs)
   
   • Designed for those enrolled in Original Medicare (Part A and Part B).
   • Helps cover the cost of prescription medications.
   • Works alongside Medicare Supplement (Medigap) plans.

1. Medicare Advantage Prescription Drug Plans (MAPDs)
   
   • Combines Medicare Part A (hospital), Part B (medical), and Part D (prescription drugs) into a single plan.
   • Offered by Medicare-approved private insurance companies.
   • Additional benefits may include dental, vision, and hearing coverage.

• Medicare Part D covers:
  ✅ Brand-name and generic prescription drugs.
  ✅ Vaccines recommended by the CDC (e.g., shingles, tetanus).
  ✅ Medications required under each plan’s formulary (drug list).

• It does not cover:
  ❌ Over-the-counter medications.
  ❌ Drugs covered under Medicare Part B (such as some cancer medications).
  ❌ Weight loss, cosmetic, or fertility drugs.

📌 Each plan has a different formulary. Be sure to review your specific plan to see if your prescriptions are covered.

💲 Costs vary by plan and typically include:

• Monthly Premium – The amount you pay for your drug plan each month.
• Annual Deductible – The amount you must pay before your plan starts covering medications. (Some plans have a $0 deductible for generic drugs.)
• Copayments & Coinsurance – A fixed amount ($) or percentage (%) you pay for prescriptions.

💡 Extra Help is Available!
Low-income individuals may qualify for the Extra Help program to reduce Part D costs, including lower premiums and copays.

✅ Who Can Enroll?

• Anyone who is eligible for Medicare Part A and/or Part B.
• You must live in the service area of the plan you choose.

📅 When to Enroll:

• Initial Enrollment Period (IEP) – 3 months before and after your 65th birthday.
• Annual Enrollment Period (AEP) – October 15 - December 7 (coverage starts January 1).
• Special Enrollment Period (SEP) – Available for qualifying life events (e.g., moving, losing employer coverage).

⚠️ Avoid the Late Enrollment Penalty – If you don’t enroll when first eligible, you may pay a penalty unless you have creditable drug coverage (such as from an employer).

When comparing Medicare Part D plans, consider these factors:

• Premiums and Deductibles: Monthly premiums and annual deductibles vary by plan.
• Copayments and Coinsurance: Your share of the cost for medications depends on the plan’s tier structure.
• True Out-of-Pocket Costs (TrOOP): Includes all costs you pay toward your prescription drugs, which count toward catastrophic coverage.
• Plan Restrictions:
  • Quantity Limits: Restrictions on how much medication you can receive at one time.
  • Prior Authorization: Some medications require approval from your plan before being covered.
  • Preferred Pharmacy Networks: Using in-network or preferred pharmacies may lower your costs.

• As of 2025, the Coverage Gap (Donut Hole) will no longer exist.
• Beneficiaries will have an out-of-pocket spending cap of $2,000 for prescription drugs.
• After reaching this cap, catastrophic coverage begins, significantly reducing your costs for the rest of the year.

There is no one-size-fits-all solution for prescription drug coverage. To find the best plan for your needs, consider:

• Your Medications: Ensure your prescriptions are included in the plan’s formulary.
• Budget: Review costs, deductibles, and out-of-pocket costs.
• Health Needs: Evaluate whether a stand-alone PDP or a Medicare Advantage plan with drug coverage is better for your situation.

At Buckeye Medicare Services, we specialize in helping you navigate Medicare Part D and Medicare Advantage plans. With our unbiased guidance, you can find the coverage that fits your medications, budget, and lifestyle.

📞 Call us today at 513-848-5203 or visit buckeyemedicare.com for a personalized consultation with a licensed insurance agent.

Don’t wait—ensure you have the right prescription drug coverage for your needs!