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am I eligible for part d

Am I Eligible For Part D?

When you first enroll in Medicare, yes, you are eligible for Part D. In fact, all you have to do to be eligible is be enrolled in either Medicare Part A and/or Medicare Part B.

Medicare Part D Premiums

Most individuals enrolled in Medicare Part B (where a premium is required) pay a separate premium for Medicare Part D. Your premium will vary according to the plan you select. Do not always choose the cheapest one, though. You must check your plan’s formulary, or list of prescription drugs covered, to ensure your medication is covered under your Medicare Part D Plan

If you are enrolled in a Medicare Advantage Plan (Part C) that already has prescription drug coverage, then your monthly premium may already include the premium for drug coverage.

Medicare Part D Deductibles and Copays

As of 2021, no Medicare prescription drug plan can have a deductible higher than $445. Some do not even charge a deductible. Those without a deductible are more likely to have higher premiums and copays, though. Most drug plans also include a coverage gap, also known as a “donut hole,” meaning there’s a brief limit on what your prescription drug plan will cover. Everyone does not enter into this donut hole, and it starts when you have spent a certain amount on covered medications on your prescription drug plan formulary. As of 2021, if you are enrolled in a Medicare prescription drug program, you must spend $4,130 to fall into this coverage gap. This amount may vary year to year, but if you receive Extra Help to help with Part D costs, you will never fall into this coverage gap.

Medicare Part D plans are accompanied by a list called a formulary, which is a list of prescription drugs covered by your drug plan. These prescription drugs that are covered under this Part D plan are divided into “tiers,” or different groups that prescription drugs fall under in order to lower costs. 

A basic Medicare plan’s Part D tiers are divided as such:

  • Tier 1: most generic drugs, usually the cheapest
  • Tier 2: preferred, brand name drugs, medium cost
  • Tier 3: non-preferred, brand name medication, higher copay cost 
  • Specialty Tier: extremely high-cost prescription drugs, highest copay

Each plan is allowed to adjust their tiers as they see fit. 

Medicare Part D Extra Help Eligibility

Medicare Part D offers a prescription drug cost opportunity that helps with the cost of your drug cost. If you fall into a category of low-income or limited resources, you may qualify for Extra Help. Extra Help will help with covering your Medicare Part D drug plan, including deductibles, copays, premiums, and coinsurance. If you qualify, then your premiums and deductibles might be less, or even free, according to income level. As of 2021, generic drugs can cost no more than $3.70 and covered brand-name drugs no more than $9.20. 

To learn more about your Medicare Part D eligibility, what it covers, and how to get assistance from the Extra Help Program, reach out to Cornerstone Senior Advisors today!