Learn About Medicare Part D

Many Medicare beneficiaries will routinely fill prescriptions at their local pharmacy. Also known as Part D, this prescription drug option is a much needed benefit to those who may have potential high-out-of pocket expense for their daily medications. In 2022 it was announced, in conjunction with the H.R. 5376 - Inflation Reduction Act of 2022, that Medicare beneficiaries would start to see their out-of-pocket costs capped in 2024 through 2025. 

How to Enroll in Medicare Part D

In order to apply for a Medicare Part D prescription drug plan you must be enrolled in Medicare Part A and or Part B. Enrollment in a prescription drug plan is not automatic and you must have a valid election period to join a plan. There are two options to receive Medicare Part D benefits. One is a stand-alone prescription drug plan, and the other is a Medicare Advantage plan that includes Part D benefits. 

The Initial Election Period (IEP) happens when you first become eligible for Medicare benefits, like turning age 65. You'll have an opportunity to research and 

Even if you don't take any prescribed medications, enrolling in a Medicare Part D plan when you are first eligible, will help prevent any future lifetime penalties.

pick a plan based on your prescription needs. Another opportunity to join a plan is created when you have a Special Election Period (SEP). The most common would be losing employer group health benefits. As long as your employer has more than 20 employees and the plan benefits are as good or better than Medicare Part D, then you can delay your enrollment without future penalties. There are many more SEP's that you may qualify for, like moving out of your plans service area, becoming eligible for Medicaid or Extra Help.

When you're ready to join a Medicare Part D plan, our agents will research all available plans in your service area, and make a recommendation based on your medications, and the pharmacy you use. We'll provide you with a breakdown of the cost of each medication and an annual cost analysis. 

Medicare Drug Plan Costs

All Medicare Part D prescription drug plans will have a monthly premium, deductible, copays and coinsurance.These costs will vary depending on the plan you enroll in. Premiums will also vary depending on the plan you choose. Variations in Part D plan deductibles span a wide range, from $0 to $500 or more, again depending on the plan you choose. In 2023 the maximum set by the federal government is $505, and in 2024 the maximum deductible will be $545.

Higher income earners will pay more for their Part D plan. This extra premium is calculated just like the Medicare Part B premium. The Income Related Medicare Monthly Adjustment (IRMMA) is based on your tax filing status, and the extra amount is based on your Modified Adjusted Gross Income (MAGI) from two years prior.  Social Security will adjust your IRMMA at the beginning of each year, and as you age into your retirement years the additional premium (IRMMA) should reduce to the point where it's eliminated. 

Getting help to pay for your prescriptions

Each year the Medicare Annual Enrollment Period (AEP) begins October 7th through December 15th. This is the period of time that allows you to change your drug plan for the following year. Whether you have a stand-alone drug plan or a Medicare Advantage plan you can either keep your current plan of change to another one. You can only be enrolled in one prescription drug plan. 

Getting help to pay for your prescriptions

The Federal Government's Part D Extra Help program is a subsidy designed to assist low-income individuals with their prescription drug costs. This program is specifically targeted towards Medicare beneficiaries who have limited income and resources. The Extra Help program provides financial assistance to cover the costs of prescription drugs, including premiums, deductibles, and copayments. It ensures that low-income individuals have access to necessary medications without facing excessive financial burden.

To qualify for the Part D Extra Help program, individuals must meet certain income and resource requirements. The income limit varies depending on the individual's marital status and household size, and the resource limit includes assets such as bank accounts, stocks, and bonds. If eligible, beneficiaries receive assistance in paying their Part D premiums, and they may also have reduced or no copayments for their prescription drugs. This program plays a crucial role in ensuring that low-income individuals can afford the medications they need to manage their health conditions, promoting better overall health outcomes and reducing healthcare disparities.

Late enrollment penalties for Medicare Part D

Timing is everything when it comes to Medicare. If you don't get it right, you're going to face potential lifetime penalties and in addition, you may have to wait before you can enroll in a plan. The easiest way to avoid the possibility of any late enrollment penalty is to understand what your enrollment period is. When you're new to Medicare there are only two enrollment opportunities. The Initial Enrollment Period (IEP) and the Special Enrollment Period (SEP). 

 Work with a licensed agent

     for smart insurance choices.

Questions & Answers

Does Medicare cover my prescription medications?


Why do I need Part D if I have no medications?

How do I avoid the Part D penalty?


When can I change my Part D plan?


Does Medicare cover drugs that come from Canada?

If you find yourself order prescription medications from a reliable FDA approved pharmacy in Canada, just know that Medicare or your Part D plan will not pay for these. Many people have found that more expensive drugs can be safely order from Canadian drug stores and save money doing so without using Medicare. 


Medicare can be confusing for most. We want to help you navigate the many options available to you, so please call us directly at (800) 405-4802 and chat with our insurance advisors for help.

Spread the news and share with your friends.