What is Medicare Part D?

Medicare Part D Prescription Drug Coverage can be one of the more complicated parts of Medicare to understand.

Susan Grossinger, senior services coordinator and SHIP Medicare counselor at Advocate Health Care shares six ways to break down Medicare Part D.

What is Medicare Part D?

The Medicare Part D program is an optional prescription drug program available to those on Medicare Part A and/or Part B.

How can you obtain Part D Prescription Drug Coverage?

Part D Prescription Drug Coverage is available as stand-alone plans or as Medicare Advantage Plans (MAPD) that include prescription drug coverage, Grossinger says. You must have both Part A and B to join a MAPD plan.

Do you really need prescription drug coverage?

Even if you do not currently take any prescription medications, you may still want to enroll in a stand-alone Part D plan or Medicare Advantage Plan (MAPD) as you never know when you may need prescription drug coverage.  The Medicare Part D program helps to cover the costs of the prescriptions you take.

“Individuals must be mindful of enrollment periods and the risk of incurring late enrollment penalty fees if you do not enroll when you are initially eligible to do so. There also are certain times during the year that you can sign up once out of the initial or a special enrollment period,” Grossinger says.

When should you review your Medicare Part D coverage?

Every year during the Medicare Annual Open Enrollment Period (AEP) which runs from Oct. 15 to Dec. 7 with the changes taking effect Jan. 1. Just as a beneficiary may have changes with their current prescriptions or the pharmacy they want to use, the insurance companies which offer these plans sign new annual contracts with Medicare and can make changes as well.

To avoid any unforeseen limits of coverage, formulary (list of drugs included in plan) changes, and cost changes, review your current plan and determine if it still fits your needs for the following calendar year, Grossinger says.

How to identify which Part D or MAPD plan is best for you

Grossinger shares three ways to help identify, which plan might be best for your coverage needs:

• Select the plan that includes the medications you take.
• The pharmacy you wish to use.
• The total out of pocket costs between premiums, deductibles and copays for prescription medications.

As complicated as it sounds to review your coverage annually, it can be well worth the effort.  For those with a lower income, there are also additional programs that work with your Part D or MAPD coverage to help lower the cost of the prescriptions even further.

The Inflation Reduction Act’s impact on Medicare Part D prescription drug coverage

The Inflation Reduction Act signed into law on August 16, 2022, includes several provisions to lower prescription drug costs for people with Medicare.

• Cap out-of-pocket spending for Medicare Part D enrollees and make other Part D benefit design changes.
• Limit monthly cost sharing for insulin to $35 for people with Medicare.
• Eliminate cost sharing for adult vaccines covered under Medicare Part D. This includes the costly Shingles vaccine and the RSV vaccine.
• Expand eligibility for full benefits under the Medicare Part D Low-Income Subsidy Program, beginning in 2024.

What are some available Medicare resources?

• Register for a live educational webinar presented by a state certified SHIP Medicare counselor to learn more about your Medicare open enrollment options and 2024 Medicare updates including changes in Part D prescription drug coverage.
• Contact our Medicare Solutions Team at 855-908-7910 to speak with one of our IL or WI SHIP certified Medicare counselors and/or schedule an appointment to review your Medicare plan options for 2024. You can also email questions to the team at asc-advocatemedicare@aah.org.
• For additional information and resources, visit our Medicare resources website.
  • Illinois residents can visit com/medicare.
  • Wisconsin residents can visit org/medicare
• To view and compare all 2024 available plans in your area, visit the Medicare plan finder at medicare.gov/plan-compare or call 1-800-MEDICARE.