Part D Prescription Drug Plans

When can I enroll?

You can sign up for a Part D Prescription Drug Plan, which helps cover prescription drug costs, along with other components of Medicare anytime beginning three months before the month you turn 65, the month you turn 65 and up to three months after the month you turn 65.

For example, if you turn 65 on May 5th, your eligibility period starts February 1st and ends on August 31st.

If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.

It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after your Medicare Part A if you don't have equivalent drug coverage from another source, such as an employer group plan, a retiree plan or VA prescription benefits.

Let us help you with when to enroll.

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 open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.

There are other times you may be able to join a stand alone Prescription Drug plan or a Medicare Advantage plan if you qualify for a Special Election Period.  You may be eligible for a Special Election Period if you have lost an employer group plan, have moved to a new area or qualify for your state's pharmaceutical assistance program.  These are just a few of the Special Election periods available.  Please contact us to find out more information.

Making Part D work

Most Prescription Drug Plans have a coverage gap called the donut hole. This means there's a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. For 2016, you're in the coverage gap once you and your plan have spent $3,310 on covered drugs. People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Once you reach the coverage gap in 2016, you'll pay 45% of the plan's cost for covered brand-name prescription drugs. You get these savings whether you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.

Although you will only pay 45% of the price for the brand-name drug in 2016, 95% of the total cost will count as out-of-pocket costs which will help you get out of the coverage gap.

In 2016, you'll pay 58% of the price for generic drugs during the coverage gap. The coverage for generic drugs works differently from the discount for brand-name drugs.  For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.

What you pay for brand-name and generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020.

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs and we are here to help you!

Getting financial help with your drug costs

Individuals with annual incomes of less than $17,820 and financial resources of less than $13,640, or married couples with an annual income less than $24,030 and financial resources of less than $27,250, may qualify for Extra Help from Medicare to help pay their Part D premiums and out-of-pocket drug costs.

Even if your annual income is higher, you still may be able to get some help.  Some examples where you may have higher income and still qualify for Extra Help include if you or your spouse:

  • Support other family members who live with you
  • Have earnings from work
  • Live in Alaska or Hawaii

Many states have pharmaceutical assistance programs.  Please call us for more information.


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

Read about the six ways to lower your drug costs on Medicare.gov.

This information was obtained from www.medicare.gov

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