Medicare beneficiaries who are signed up for Medicare Part A and Part B and live within the Part D plan’s coverage area can sign up for Medicare Part D.
Qualifying for Medicare Part D
To be eligible for a Medicare Part D plan, you must first be enrolled in Medicare Part A and Part B. Thus, you must be eligible for Medicare.
To be eligible for Medicare, you must be either 65 or older or have a disability and receive disability benefits for at least 24 months. People with amyotrophic lateral sclerosis (ALS) can receive Medicare the same month they begin receiving disability benefits. People with End-Stage Renal Disease (ESRD) are eligible for Medicare during the fourth month of a regular course of dialysis treatment or the first month of at-home dialysis treatment when conditions are met.
What is Medicare Part D?
Medicare Part D is prescription drug coverage. These plans will vary in the drugs they cover and their pricing. You purchase these plans in addition to Original Medicare. Some Medicare Advantage plans will even include prescription drug coverage as an added benefit.
How Medicare Part D Works
Once you pay your plan deductible, you pay only small copayments for each prescription. These copayments are based on whether the drug is generic, brand-name, or specialty and preferred or not preferred. Costs are arranged in tiers with the lowest copayments associated with generic, preferred drugs.
All plans are required to cover at least two drugs in the most commonly prescribed categories, including anticancer, anticonvulsant, antidepressant, antipsychotic, antiretroviral, and immunosuppressant drugs. To see which prescription drugs will be covered by a particular plan, you can view the plan’s formulary. Make sure the prescriptions you need will be covered before you sign up.
What You Pay for Medicare Part D
You pay a plan premium for your Medicare Part D. If your income is beyond a certain threshold, you may have to pay a Part D Income Related Monthly Adjustment Amount (IRMAA) directly to Medicare in addition to your premiums. You pay your plan’s deductible before your coverage kicks in, then you pay the assigned copayments for each prescription drug when you fill them at the pharmacy.
Ready to purchase Medicare Part D? Talk to one of our specialized agents at Magellan Healthcare to find the coverage that works best for you.
