Medicare Part D prescription drug coverage is sold by Medicare-approved private companies. Each company sets the pricing for the plans it offers.
There are multiple components that contribute to the cost of your prescription drug coverage.
Medicare Part D costs include:
You will not have to pay a premium for Medicare Part A if you or your spouse have worked and had payroll taxes deducted for ten years (40 quarters) or more. That is called premium-free Part A.
You will pay a monthly premium for Medicare Part B. The amount varies depending on your income.
This is not part of your plan’s premium. The payment will go directly to Medicare. The amount will be deducted from your Social Security benefits or you will receive a bill. To keep your prescription drug coverage, you will need to pay the extra amount.
The Social Security Administration will contact you if you have to pay Part D-IRMAA.
You will probably never reach the coverage gap if you do not have a lot of prescriptions or expensive prescriptions.
Your Part D plan’s Summary of Benefits includes information on the specific spending range for the coverage gap and your benefits while you are in the coverage gap.
If you spend above the upper limit of the coverage gap, you qualify for catastrophic coverage. If you have catastrophic coverage, almost all of your drug costs will be covered.
If your medication is not on the formulary, your provider may be able to help you find a similar drug that will work just as well. Your provider can also apply for an exception if he or she believes a specific drug is important to your health.
Every drug on the formulary is in a tier that reflects the price range for the prescription. In general, the higher the tier number, the higher your cost for the drug.
Medicare Part D plans provide information about the costs of drugs in each tier in their Summary of Benefits available online.
You may have to pay a late enrollment penalty if you don’t sign up for Part D when you are first eligible, or if you have a gap in creditable drug coverage through another health insurance plan. The penalty will be added to your monthly premiums and you will have to pay it for as long as you have Part D. The longer you go without enrolling, the more the penalty will be.
If you are notified that you have a Part D-IRMAA, you are required to make payments directly to Medicare, not your Medicare Part D plan. You will get a bill each month from Medicare. To keep your prescription drug coverage, you will need to pay the extra amount.
There are several ways you can pay Part D-IRMAA
You can elect to have your Part D premium deducted from your retirement benefits each month. Or, you can get billed directly by your plan.
There are several ways you can pay your Medicare Part D premium:
Prescription Savings Programs and other assistance programs can help you pay for prescription costs if you have limited income and resources.
Contact Banner Medicare so we can answer any questions you may have and even help you enroll.
Call (888) 788-1931 (TTY 711) to speak with a licensed sales agent.
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