What Is Medicare Part D?

Of all the parts of Medicare, Part D can be the most confusing.

But don’t fret. At Florida Medicare Specialists, our goal is to help you fully understand all of the parts of Medicare, especially Part D, and the dreaded “donut hole.”

It’s important that you understand all parts of Medicare so you can be sure you’re cared for during retirement. If you’re looking for information on various Medicare parts, enrollment, and more, head here.

In a nutshell, Part D is your prescription drug coverage. Most of us may require some type of prescription assistance at some point in our lives, even if they aren’t long term medications, and unfortunately that tends to become more common as we get older.

One important note is that you can elect to have stand-alone Part D coverage, or include it in a Medicare Advantage Plan (MAPD).

The difference between these is that the stand-alone option will require a monthly premium while the MAPD option does not because it is already included in your plan.

One Part, Multiple Stages

All Part D plans consist of different stages, and your costs change throughout the year depending on the stage that you are in.

Deductible Stage

In the deductible stage, you will pay for your medications out-of-pocket much like a traditional deductible for health insurance.

If your plan has a $0 deductible, you would skip straight to the next stage. Some plan deductibles may also only apply to medications on specific tiers, and the maximum deductible is $590.

Initial Coverage Stage

In this stage, you’ll pay your plan copays or coinsurance, your plan pays the rest.

Once you, and others on your behalf, have paid a combined total of $2,000 (called the Maximum-Out-of-Pocket), which includes the amount you paid towards your deductible, you move to the Catastrophic Coverage stage.

 

Catastrophic Coverage Stage

If you reach the catastrophic coverage stage you will pay nothing for covered prescriptions for the balance of that year.

This is the most significant change in Part D coverage since addition of Part D in 2006.

Although reaching the Catastrophic Coverage Stage requires you and your plan to pay $2,000 toward prescription costs for during 2025, this does not mean you will pay that much.

This is true because the portion your plan pays for each prescription counts toward the $2,000 (Maximum-Out-of-Pocket).

For any Senior who reached “the donut hole” in the past, this new Maximum-Out-of-Pocket provision will likely make a huge difference in annual prescription drug costs to them.

Please read my blog titled, “No More Donut Hole!!”

Get the Medicare Part D Help You Need

Costs can pile up for many seniors when it comes to prescription drugs, and one program that can help alleviate those costs is Extra Help.

Extra Help can save enrollees up to $5,300 a year on their prescription drug costs, and it’s easy to apply for the program.

The best way to get help with Medicare is to reach out to the experts at Florida Medicare Specialists.

We’ll answer any question you have and make sure you’re fully informed about your Medicare options.

Connect With Ken To Learn More About Medicare Part D

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