What is Part D?

Medicare offers prescription drug coverage, also known as Part D, to everyone with Medicare. To get Part D, you must join a plan run by an insurance company approved by Medicare. Each plan can vary in cost and the drugs covered, and plans can change from year to year. A plan that covers your prescriptions this year may change and not cover them next year. Members of a Part D plan will be informed of any changes made to their plan for the next calendar year in a document called the Annual Notice of Change. The Center for Medicare and Medicaid Services (CMS) requires that all Part D plan sponsors provide this document to their members every year. Members generally receive this document in September.


If you are already enrolled in Part D, it is important to review your coverage every year, which you can do during the Open Enrollment Period, October 15th to December 7th every year.


Why do I need Part D Medicare? First of all, Original Medicare does not provide any prescription drug coverage. We all want to stay in good health, but no one can predict the future. Part D plans are insurance that covers the cost of prescription drugs. If you take drugs now or if you do not and your health changes or you need more medicines, this insurance will help pay for your drugs and protect you from very high drug costs. If you choose not to enroll in Part D, you may face a late enrollment penalty, depending on your circumstances, and have to pay higher monthly premiums for the rest of the time you have drug coverage from Medicare.


Many states have low-cost Part D plans that can act as a safety net in case your health situation changes. Consider this if you don’t take prescription drugs now to protect yourself in the event your situation changes before the next enrollment period.


Can I simply keep my current drug coverage and not get Medicare Part D?

In some cases, you may be able to keep your current prescription drug plan and not join a Part D plan. This occurs when your current drug plan is considered creditable coverage, meaning it is as good as Medicare Part D. Creditable coverage information is usually found in the materials provided by your employer health plan. Keep the document in case you should decide to sign up for Medicare drug coverage in the future. Remember, if you do not have creditable coverage and delay your enrollment in Part D, you will have to pay a penalty for the life of your Part D plan coverage.


What pharmacy can I use with Part D? Your Medicare Part D plan will have identified pharmacies in your area to be part of its network. These are the pharmacies you will have to use to get your drugs. Medicare has set guidelines so that the network of pharmacies will be convenient for you. These network pharmacies should be within a certain distance from where you live.


You will be able to ask the plan which pharmacies are in their network. You may want to look for a plan that has your favorite pharmacy included in its network before you enroll. Sometimes, you may need to get drugs from a drugstore that is not in your network, called an out-of-network pharmacy. Part D plans must give you “adequate access” to drugs at out-of-network pharmacies when you cannot get your drugs at a network pharmacy. Part D plans want balance – they want to make sure you can get drugs when you need them but not use out-of-network pharmacies unless you have to.


If you still have questions about Part D of Medicare, give a call at 1-844-680-7855. Or click here and shop for a Part D plan in your area.

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