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Medicare Part D

What Medicare Part D covers?

Medicare Part D is also referred to as Prescription Drug Coverage. These plans are provided by private insurance companies as alternative to coverage managed by the Federal Government. The plans while offered by private insurance companies are contracted by the Federal Government and have guidelines the must follow. 

Drug plans will break prescriptions into different tiers, typically they are broken down into 5 tiers. 

Tier 1: Preferred Generics

Tier 2: Non-preferred Generics

Tier 3: Preferred Brand

Tier 4: Non-preferred Brand

Tier 5: Specialty

Some drug plans may have less tiers or more tiers, but all drug plans will cover certain categories of drugs including: anticancer drugs, antidepressants, antipsychotics, immunodepressions, HIV/AIDS drugs, seizure drugs, and Vaccines.

Every drug plan must have drugs in their formulary that fall into the categories, but do not have to provide coverage to all drugs available in that category. With coverage being provided, drugs may also have usage or quantity restrictions, along with prior authorization requirements and step therapy. 

AIS Medicare & More agents specialize in Medicare insurance and are going to work to ensure that the plan you choose is the option that meets your health and financial needs

Who Qualifies for Medicare Part D

Anyone that has Medicare Part A and/or Part B qualifies to get a Medicare Part D, Prescription Drug Plan. You must keep either Part A or B active or both active to maintain a drug plan.

How Much does Medicare Part D cost

Prescription Drug Plan costs will vary depending on the plan you have, drugs you take and even the pharmacy you use. Many drug plans come with a monthly premium, in some areas this can be as low as $0 month in 2024.

Prescription Drug Plans can be broken down into a 4 phases of coverage:

Deductible Phase: The first phase is your annual deductible, in 2024 the highest this can be is $545. 

Initial Coverage Phase: The second phase is called 'initial coverage phase' this is where you pay a copay or a coinsurance amount for your drugs, this phase is active until you and your plan have paid $5,030 towards drug costs.

Coverage Gap: The third phase is called the 'Coverage Gap' or 'Donut hole' in this phase you will pay 25% or less for drugs.

TROOP: This fourth phase is the 'True Out of Pocket' costs. In 2024 once your TROOP hits $8,000 for the year your drug costs are $0 the rest of the year. The True Out of Pocket costs takes into consideration your deductible costs, your copays and coinsurance costs during the initial coverage phase, your coinsurance costs during the donut hole and the manufacture costs during the donut hole. Once all of those costs reach $8,000 your costs go to $0 the rest of the year for your drugs.

The phases of Part D can be a little confusing, this image is to help illustrate how they work. 

If you would like more clarification, just give us a call!

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