Things to Know About Medicare Part D Plans

Medicare Part D is prescription drug coverage offered through private insurance companies approved by Medicare. It helps reduce the cost of medications and offers protection against high prescription expenses. Weadock & Associates LLC provides medicare part D in Grand Rapids, MI, Kentwood, MI, Walker, MI, Wyoming, MI, Forest Hills, MI and surrounding areas.

Understanding how these plans work is key to choosing the right coverage.

Part D plans are optional, but if you don’t enroll when you’re first eligible and lack other credible drug coverage, you may face a permanent late enrollment penalty. You can join a stand-alone Part D plan if you have Original Medicare, or you can get drug coverage through a Medicare Advantage plan that includes prescription benefits.

Each plan has its own formulary, or list of covered drugs. Formularies are divided into tiers, with lower tiers generally covering generic medications at lower costs and higher tiers including brand-name or specialty drugs with higher copayments. It’s important to confirm that your prescriptions are included in the plan’s formulary before enrolling.

Part D plans also have preferred pharmacy networks. Using pharmacies within the network typically results in lower out-of-pocket costs. Mail-order options are often available for convenience and potential savings.

Costs for Part D include a monthly premium, annual deductible, and copayments or coinsurance for prescriptions. These costs vary widely by plan. Higher-income beneficiaries may pay an additional income-related monthly adjustment.

Coverage is structured in phases: the initial coverage period, the coverage gap (often called the “donut hole”), and catastrophic coverage. While the coverage gap has been reduced in recent years, beneficiaries may still pay a percentage of drug costs until they reach catastrophic coverage, where costs drop significantly.

Want to discuss this further? We’re available by phone or email.