You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.
It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.
Let us help you with your enrollment
If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Making Part D work
In 2024, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will be $8,000 in 2024.
The standard deductible is $545 in 2024. While the initial coverage limit is $5,030.
For costs in the coverage gap phase, beneficiaries pay 25% for both brand-name and generic drugs, with manufacturers providing a 70% discount on brands and plans paying the remaining 5% of brand drug costs and the remaining 75% of generic drug costs. For total drug costs above the catastrophic threshold in 2024, Medicare will pay 80% and plans will pay 20%.
Changes to Part D under the Inflation Reduction Act
These changes take effect in 2023 and will continue phasing in over the next couple of years.
The law:
-Limits the price of insulin products to no more than $35 per month in all Part D plans and makes adult vaccines covered under Part D available for free in 2023
-Requires drug manufacturers to pay a rebate to the federal government if prices for drugs covered under Part D and Part B increase faster than the rate of inflation, with the initial period for measuring Part D drug price increases running from October 2022-September 2023
-Expands eligibility for full benefits under the Part D Low-Income Subsidy program in 2024
-Shifts more of the responsibility for catastrophic coverage costs to Part D plans and drug manufacturers beginning in 2025
-Adds a cap on out of pocket drug spending under Part D by eliminating the 5% coinsurance requirement for catastrophic coverage in 2024 and capping out of pocket spending at $2,000 in 2025
-Authorizes the Department of Health and Human Services to negotiate the price of some drugs covered under Medicare, with negotiated prices first available for 10 Part D drugs in 2026
Choosing a plan
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. There’s a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year
Call us to help you understand your options.
Getting financial help
Individuals with annual incomes of less than $21,870 and financial resources of up to $16,600, or married couples with incomes of less than $29,580, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
Download Medicare’s instructions on applying for the Extra Help program.
Additionally, read about the six ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
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Important disclosures about Medicare Plans: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.