Medicare Part D
PrescriptionCoverage

Prescription medicine given to you in a hospital or administered by a health care provider is covered by Medicare Part A and B respectively but an antibiotic or blood pressure medication you get at your pharmacy are not. That’s the function of Medicare Part D coverage.

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Traditional Medicare Part D Coverage

At your initial enrollment for Medicare you will likely be given Part A Medicare at no cost, offered Part B and Part D which are both provided along with a premium that you will pay for each.

Part B is a government program Part D is provided by a third party insurer or drug plan provider. If you sign up for a Medicare Advantage plan during your initial enrollment period it very likely will include a Part D plan.

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Part D and You

Part D coverages all have something called a Formulary and you should receive a copy. In it you will find a listing of all the medications that your Part D will pay for. Every Part D provider by regulation must provide at least two medications for most common illnesses and ailments

Check the formulary to make sure your drug is covered. If it is not you may appeal,or ask your health care provider to provide you with a covered drug or generic to replace it. Generic drugs if available are generally less expensive.

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Deductibles, Copays and Donut Holes?

Every Part D plan has a deductible that must be met before you receive the full benefit of the program. Prior to that deductibles being met you will pay a percentage of the price negotiated between your provider and the drug company.

Once that deductible is met then each prescription you have filled may require a small copayment to have it filled. The donut hole is a gap in coverage that is created when you have spent the allotted amount for medications, in 2020 it was $4,020, and before you reach the out of pocket maximum.There is a formula at medicare.gov for further information.

Medicare Advantage Plans and Part D.

  • Many Medicare Advantage Plans as well as Medigap coverage provide for coverage in the donut hole so the insured may see no significant cost increases.

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