Medicare Part D
Medicare Part D offers you prescription drug coverage so you can pay for the medications you need.
Medicare Part D
Who is Eligible for Medicare Part D?
If you have Original Medicare, you can get Medicare Part D. If you choose not to get prescription drug coverage when you’re first eligible, you may have to pay a late enrollment penalty to join later. This penalty is usually paid for as long as you have Medicare Part D, so enrolling in Part D when you’re first eligible for Medicare is typically a good idea.
What’s Covered Under Medicare Part D?
All Medicare Part D plans cover a wide range of prescription medications, including most drugs in certain protected classes such as drugs to treat cancer and HIV/AIDS. However, each plan has a formulary (its own list of covered drugs), so you’ll need to refer to that list to know whether your regular medications are covered by a particular plan.
To lower your costs, most Medicare Part D plans place drugs into different “tiers” with drugs in each tier having different costs. Usually, the tiers are as follows with tier 1 being the most inexpensive and the speciality tier being the most expensive:
- Tier 1: most generic prescription drugs
- Tier 2: preferred, brand-name prescription drugs
- Tier 3: non-preferred, brand-name prescription drugs
- Speciality tier: very high cost prescription drugs
Tier 1
Most generic prescription drugs are tier 1 drugs, and they have the lowest copayment. A copayment is the amount you are required to pay as your share of the cost for a medical service or supply and is usually a set amount, rather than a percentage.
Generic prescription drugs work the same as their brand-name counterparts. They are medications created to be the same as existing brand-name drugs in their safety, dosage form, quality, strength, performance characteristics, and route of administration.
Generic drugs:
- Have the same active ingredient as the brand-name drug
- Have the same strength, use indications, form, and route of administration as the brand-name drug
- Have acceptable (per FDA standards) inactive ingredients
- Are manufactured under the same safety standards as the brand-name drug
- Have the same label as the brand-name drug
In short, generic drugs usually do the same job as prescription drugs but for less money. For most Medicare Part D plans, you’ll pay around $1 to $3 copayment for drugs in tier 1.
Tiers 2 and 3
Tier 2 drugs are preferred, brand-name medicines and tier 3 drugs are non-preferred, brand-name drugs.
Preferred brand-name drugs are brand name drugs that don’t have a generic equivalent. They’re brand name drugs that cost the least and for many plans, you can expect your copayment to be around $38-$42.
Non-preferred brand-name drugs are higher-priced brand name drugs not in a preferred tier. They have a higher cost than preferred brand-name drugs and generics, so you should only opt for these if a generic or preferred brand-name drug doesn’t exist for the medication you need. Your copayment for these drugs is usually around 45% to 50% of the retail drug cost.
In some cases, if your drug is in a higher tier and your health care provider thinks you need that specific drug instead of one in a lower tier, you can ask your plan for an exception to pay a lower rate.
Speciality Tier
Specialty tier drugs are the most expensive drugs in the formulary. They can be generic or brand-name and are used to treat complex conditions such as cancer, HIV/AIDs, and multiple sclerosis. For most plans, you’ll pay around 25% to 33% of the retail cost for these drugs.
Not Sure If Medicare Part D is Right For You?
Senior Health Solutions in Opelika, AL can help you decide. We understand how important it is to find the right coverage, that’s why we will go above and beyond to make sure you get the coverage you need. Give us a call at (866) 445-5215 today to learn more about Medicare Part D and how it can benefit you.
