Paying for Medicare Part D

By Gary Phillips

Medicare Part D is the prescription drug coverage of Medicare. Medicare Part D is outlined in Medicare Prescription Drug Coverage.

What You Pay for Medicare Drug Coverage

Typical costs throughout the year are:

  • Monthly premium
  • Annual deductible
  • Copayments/coinsurance
  • Costs if you get Extra Help
  • Costs during the coverage gap
  • Costs if you pay a Late Enrollment Penalty

Factors Affecting Part D Costs

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether your drugs are on your plan’s formulary
  • Whether you go to a pharmacy in your plan’s network
  • Whether you get Extra Help paying your Part D costs

*NOTE: This data is believed to be accurate as of 06/2012, but not guaranteed. For specific, up to date information, contact Medicare or your State Health Insurance Assistance Program (SHIP), if applicable. This chart is just a “model” for Medicare Part D (PDP) coverage. Actual insurance plans can differ greatly so be sure to shop and compare closely and have any current prescriptions readily available.

Monthly Premium

Monthly fees vary by plan and could be higher based on income. You may have your premium deducted from your monthly Social Security payment.

Annual Deductible

This is the amount you must pay each year for your prescriptions before your Medicare drug plan kicks in. Deductibles vary between plans but can never be higher than $320 in 2012.

Copayment/Coinsurance

This is the amount you pay for each of your prescriptions after you have paid the deductible. Some plans have different levels or “tiers” of coinsurance or copayments, with different costs for different types of drugs.

This means you pay a percentage of the cost of the drug (for example, 25%). With a copayment, you pay a set amount for all drugs on a tier (for example, $10). You’ll typically pay a lower copayment for generic drugs than brand-names.

About the Author

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com

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