Medicare Part D

Medicare Part D is a Prescription Drug benefit program that is offered in Texas as part of the wider Medicare federal health insurance program. It is for persons 65 years and older, certain younger people with disabilities, and people with end-stage renal disease (ESRD). Part D is an optional benefit that is administered by private insurance companies and available to anyone who is enrolled in Original Medicare, Part A, and Part B.

Medicare Part D Coverage

Every Part D plan has a formulary, which is a list of drugs that are covered. If the drug you require is not on the formulary, you may request an exception, pay out of pocket, or submit an appeal. 

The formularies vary from plan to plan, so you should request a copy. But each plan has to cover all drugs in these categories:

  • Antidepressants
  • HIV/AIDS treatment
  • Immunosuppressants
  • Antipsychotic medications
  • Anticonvulsive treatments for seizure disorders
  • Anticancer drugs (unless they are being covered under Part B)

Also, Part D covers most vaccines unless they are already covered under Part B.

For more information about Medicare Part D coverage, look here.

Part D Cost

Monthly premiums and copayments for Part D vary from plan to plan.

However, as previously mentioned, every plan has a formulary that records the different drugs that are covered. The cheapest plan is not always the best plan. Talk with a Medicare agent like Ron Ray who will verify that the plan you want will cover 100% of your drugs.

If you have a low income or think you could have trouble paying Medicare premiums, you can check for helpful options in our blog about Medicare Savings Program.

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How to Enroll in Prescription Drug Coverage

For Medicare Part D, you can only enroll in the service area where you live. You can enroll through an insurance carrier that is certified in Medicare services. Or, you can enroll through Medicare’s website.

You can enroll in a standalone Part D drug plan that goes alongside your Original Medicare (Part A and Part B) benefits, especially if you are enrolled in some Medicare Supplement plan. The other option you can choose is a Part D drug plan that is built-in to some Part C plans.

There are some Medicare Advantage plans that also contain Part D coverage. If this is how you want to get your prescription drug coverage, double check to make sure it covers 100% of the drugs you need. 

Enrollment Periods

You are able to enroll in prescription drug coverage when you enroll in Original Medicare. This is the three months before your 65th birthday and the three months after you turn 65. 

Also, the annual election period is from October 15 through December 7. You can enroll or disenroll from any drug plan during this period. 

The insurance company will send you an Annual Notice of Change every September. This is a letter that explains all changes coming regarding your plan. Then, you can choose whether or not to make a change. 

You do not have to do anything if you want to keep your current coverage. It will automatically start over in January. 

For all of your prescription drug questions, give us a call at 830-217-6711.