Typically, you can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before the month you are eligible for Medicare Part B (most often the month of your 65th birthday).

It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after the month of your Medicare Part B eligibility; unless you have equivalent drug coverage from another source, such as a retiree plan, or you qualify for a Low Income Subsidy (Extra Help).

Let us help you with your enrollment

If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the Annual Enrollment Period (AEP), which runs from Oct. 15 to Dec. 7 every year.

Understanding how Part D works

For 2023, the 1st stage of drug coverage that may need to be met is the deductible. Where applicable, that deductible is set a $505, up from $480 in 2022. Usually, this deductible is not applicable to Tier 1 Preferred Generic prescriptions. Check the plan to find out for sure. Once the deductible is met, where applicable, you enter Stage 2 of your coverage where you'll pay a copayment or coinsurance.

Stage 2 of your drug coverage is called the Initial Coverage Phase that lasts until the total cost of drugs (paid by the member and the Plan) reach $4,660 (including the deductible). Most people will remain in this phase through out the year.

Once you reach $4,660 of total drug costs, you enter Stage 3 of coverage called the Coverage Gap ("donut hole") where the member pays 25% co-insurance for generic and brand drugs, with plans & drug manufacturers paying the remaining 75% of drug cost. Some people will move into this phase at some point during the year.

Then when True out-of-pocket (TrOOP) drug costs reaches $7,400, the member enters the 4th stage of coverage called Catastrophic Coverage. TrOOP includes payments that you made and payments that were made by others on your behalf (for example, what the drug manufacturers pay). For total drug costs above the Catastrophic threshold, Medicare pays 80%, plans pay 15%, and enrollees pay either 5% of total drug costs or $4.15 (generic)/$10.35 (brands) for each drug, respectively.

Note: Read your plan's documentation about how your specific drugs are covered. Also, If a member qualifies for a Low Income Subsidy (Extra Help), different rules apply as to how much the member pays. Talk to your insurance agent if need be about this.

Summary of the Inflation Reduction Act effect on Prescription Drug coverage:

• Beginning in 2023, Insulin available at $35/month per covered prescription
• Beginning in 2023, access to recommended adult vaccines without cost-sharing
• Beginning in 2025, a yearly cap of $2,000 on out-of-pocket prescription drug costs in Medicare (Indexed in future years to Part D drug cost changes). For 2024, the law eliminates the 5% beneficiary coinsurance requirement above the Catastrophic Coverage threshold (see above), effectively capping out-of-pocket costs at approximately $3,250 that year.
• Expansion of the low-income subsidy program (LIS or “Extra Help”) under Medicare Part D to 150% of the federal poverty level starting in 2024. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty.
• Beginning in 2026, Medicare will be able to negotiate directly with drug manufacturers to lower the price of some of the costliest single-source brand-name Medicare Part B and Part D drugs. This means that people with Medicare will have increased access to innovative, life-saving treatments, and the costs will be lower for both them and Medicare.

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs.

• Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. Or call us and we can help. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year

Call us to help you understand your options.

Getting financial help

Check with your state's guidelines or ask your agent to determine what income thresholds and financial resources would allow you to qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs. These figures are adjusted in March of every year.

Download Medicare's instructions on applying for the Extra Help program.

This information was obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.