An Overview of Part D
Part D provides coverage for prescription drugs. It is only available to those that are enrolled in Original Medicare. If you’re enrolled in Medicare Advantage and would like Part D, you will need to switch your plan. Keep in mind that many Medicare Advantage policies do include prescription drug coverage, so this may not be an issue for you.
Part D coverage is divided up into different tiers, so that beneficiaries can select the tier which includes their medications. As the tiers increase in medication complexity, price will also increase. It’s incredibly important to look at the formularies and tiers before selecting a Part D plan.
Part D plans can change yearly, so it’s very important to keep track of your coverage and make sure that you’re aware of any updates. Medicare updates its plans so that they include the most recent medications and therapies. If you’re concerned about updates to your Part D policy, reach out to an insurance agent and they’ll be able to help you find another policy option.
What Is the Part D Donut Hole?
If you’re not familiar with Part D, you might be wondering what the “donut hole” is and if it could affect you. The donut hole occurs when a policy reaches the maximum amount that it will pay. This coverage gap occurs when both you and your policy have spent $4,130 in 2021.
If you’re worried about encountering the donut hole, then it might be best to consider another form of insurance. Being enrolled in multiple health insurance policies is one of the best ways to be sure that you’re lowering your bills and will have as much coverage as possible. It can be helpful to make an appointment with an insurance agent to discuss other health insurance options and if they could be the right choice for you.
Paying Once You’re in the Donut Hole
Once you’re in the donut hole, the amounts that you pay for certain medications may change. At this point, Medicare has different policies for brand name drugs and generic drugs. If a drug that you take isn’t within your coverage, consider asking your doctor if there is an alternative that would be within your coverage. Don’t be afraid to reach out to your healthcare providers and work together to find the best possible situation!
Leaving the Donut Hole
Being in the donut hole is not a forever situation and there is a way to get out. In order to be taken out of the donut hole, the total of your out-of-pocket costs must be $6,550. If you find yourself in this place, then it’s probable that your policy will cover the majority of your prescription drug costs.
Paying for prescription drugs can be expensive. While Medicare does provide substantial coverage, it is best for some to choose an additional health insurance policy. If you’re concerned about paying for health costs, know that we’re here to support you. At Cornerstone Senior Advisors, we believe in the importance of understanding your insurance policy and using it to its full extent.