There are many PDP plans to choose from with different options. Most individuals spend 75% of their time comparing PDP plans. It's important to choose one that suits you best and compliments your medication needs. Failure to enroll on time will result in a 1% penalty fee for the duration you have Medicare. With over 12 years of experience, we have in-depth knowledge of PDP plans which eliminates your needs to research on your own. We're here to help. We'd love to explain, guide you through and make sure your Medicare selections are the best. 

Prescription Drug Plans are optional for Original Medicare,  Some Medicare Cost Plans, Some Medicare Private Fee For Service, and Medicare Savings Account. It's important to note that even if you aren't taking medication now, you may be required to in the future. Those who don't sign up when first eligible, have other creditable prescription drug coverage, or receive extra help will incur a penalty that will have to be paid during the duration of having Medicare.

You must have Medicare A and/or B to join a Part D plan.

Most Medicare Advantage Plans have Part D included. 

How much is a Prescription Drug Plan?

It depends on the plan you choose, the brand of drugs, the tier the drugs are in, what phase you are in and the pharmacy you use.

There is:

• A monthly payment,
• Yearly deductible (some plans do not have this). 
• Co-payments/ co-insurance (this is what you pay for after your deductible, if your plan has one. You pay your share and Medicare covers the rest)
• Catastrophic Coverage-  Once you’ve met your plan’s out-of-pocket cost requirements for the year, you automatically get “catastrophic coverage.” With catastrophic coverage, you only pay a reduced coinsurance amount or co-payment for covered drugs for the rest of the year.  

What is the late fee enrollment Penalty?

If you don't join Medicare when you are first eligible or enroll in a Medicare Drug Plan after losing credible coverage, you will have to pay a 1% penalty for the remainder of the time you're on Medicare. The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020) by the number of full, uncovered months that you were eligible but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year. After you join a Medicare drug plan, the plan will tell you if you owe a penalty and what your premium will be.  

When Can I Join Or Switch?

• Initial Enrollment Period- 3 Months before your birthday, the month of your birthday, and three months after.
• Open Enrollment-You can join, switch, or drop a Medicare drug plan between October 15– December 7 each year. Your changes will take effect on January 1 of the following year, as long as the plan gets your request before December 7.  
• Medicare Advantage Open Enrollment: If you’re enrolled in a Medicare Advantage Plan, you can drop your Medicare Advantage Plan, switch to Medicare Advantage Plan that you need Part D With such as an MSA. You can also switch to Original Medicare and get Part D. The Medicare Advantage Open Enrollment Period starts  January 1 and runs through March 31st each year.  
• Special Enrollment Periods- A special enrollment periods will start when you   experience specific life events such as moving, marriage, diagnoses and much more.

How Do I Know My Drugs Are Covered?

Each plan has their very own list of covered drugs which is referred to as "The formulary".

Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost. Drugs in a lower tier will generally cost less than a drug in a higher tier. In some cases, if your drug is in a higher tier and your prescriber thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception.    Formularies can be changed by the plan. Your plan will notify you of any formulary changes that affect drugs you’re taking.  

Plans may have certain rules for certain drugs which includes:

• You or the prescriber may have to contact the plan before you can fill prescriptions
• Your prescriber may have to show that the drugs being prescribed to you are medically necessary for the plan to cover them
• The plan may limit how much medication you can be prescribed
• The plan and Pharmacy may conduct prescription safety checks which includes a review of drug interactions that could be fatal, incorrect dosages, and unsafe amounts of opioids or benzodiazepines.
• Some plans have Drug Management Programs in place which helps you use opioids and benzodiazepines in a safe manner. The plan will contact doctors and pharmacies if multiple prescriptions are being written and multiple pharmacies are being used.

Please contact us for a further in-depth Part D overview.