What is Medicare Part D?
Medicare Part D is a prescription drug plan. There are 2 ways you can enroll in a Part D drug plan. You can choose a stand alone Part D drug plan or you can choose to enroll in a Medicare Part C Medicare Advantage Plan that includes Part D coverage.
Through Medicare Part D, you can get comprehensive prescription drug coverage for outpatient use. The plan covers medications that are sold at pharmacies, mail order, and other sales points.
Who is Eligible for Part D in Washington
In order to get Part D plan in WA, you need to be enrolled in either Medicare Part A, Part B, or both. If you enroll in a Medicare Advantage plan you cannot also enroll in a stand alone Part D plan. To have RX coverage with your Medicare Advantage plan you would need to enroll in one that includes prescription coverage known as a MAPD
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All you pay for is the premiums, which are the same with or without our help.
Coverage and Formulary
Medicare Part D covers different types of drugs however not all plans cover all prescriptions. Medicare requires all Part D providers to include certain classes of prescription drugs in their formulary and at least two prescription drugs from the most prescribed categories.
The formulary refers to the list of drugs covered by a Part D plan. All Part D formularies must include certain HIV medications, antipsychotics, cancer treatment drugs, antidepressants, anticonvulsants, and immunosuppressants. Every year you need to review the Part D plan’s formulary to make sure all your prescription drugs are still covered as formularies change annually.
Part D plans do not offer coverage for hair loss treatments, dietary supplements, weight control drugs, and over-the-counter medications.
How Does Part D work?
You must pay your monthly Part D premium to a private insurance company
Every year Medicare will have a allowable Part D deductible. In 2022 the highest the deductible can be is $480. Part D plans can choose to have a plan with a deductible or partial deductible or no deductible.
Once you have met your deductible you will pay a flat copay or coinsurance for your prescriptions depending on your part D part. Your drug cost can vary based on the pharmacy you use. Once your cost and the insurance company’s cost together add up to $4,430 in 2022 you will enter the coverage gap.
In the coverage gap, also known as the donut hole, you will pay 25% of your RX cost until you reach $7,050 for 2022.
Once you close the coverage gap or donut hole you will be in the catastrophic coverage period where you pay at most 5% of your drug cost for the rest of the year.
How to Change Part D Plans
During the annual election period from October 15 to December 7 every year you are allowed to make changes to your Part D Medicare Coverage. Every year you can choose to shop out your Part D to see if there is a different plan to meet your needs or do nothing and stay in your current plan. Remember if you stay in your current plan there might be changes in covered drugs, RX prices or premiums in January. If your Part D plan is ending you would get a letter informing you of this change and then you would have to enroll in a new Part D plan.
If you are already enrolled in a plan typically you can choose to stay in the plan but it could have premium and benefit changes. Otherwise, you can choose to shop out your Part D to see if there is a different plan to meet your needs.
Part D Penalty
If you choose to postpone your Part D enrollment while you do not have any creditable drug coverage, you may face late enrollment fees if you later enroll in Part D. Most of our clients enroll in a Part D Plan because they are so affordable. Most years you can purchase a plan for less than $14 a month.
Why Use an Independent Medicare Broker?
You will want to make sure your plan meets your needs. Brokers have experience and access to information that is not readily available to you. This is what they do, so they know the ins and outs of finding a Medicare Prescription Drug Plan. If you have any questions about Medicare Part D in Washington state, you can contact our expert brokers anytime.
Choosing a Medicare Part D Plan
If you’re working with a Medicare Part D insurance agent in Washington, you don’t have to worry about what Part D plan to choose. It’s their job to find a Medicare Prescription Drug Plan that will fit your needs and they do it well.
If you need help choosing a drug plan, contact McGregor Benefits. We are an independent health insurance agency and are here to help you through the process of protecting yourself and your family. Our Medicare agents are experienced and helpful, and they will find a plan that meets your requirements at a low cost.
Our brokers will use their decades of experience to find a plan that’s priced just right and which’ll ensure minimal out-of-pocket expenses while providing adequate coverage. And the best part is that our services are completely free of charge!