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Medicare Part D – Drug Coverage

Apr 26, 2021 | Medicare, CSG Medicare Pros, Medicare Part D - Prescription Drug Coverage

Medicare Part D - CSG Medicare Pros Arizona

​What is Medicare Part D?

Medicare Part D provides prescription drug coverage for individuals that have Medicare. Part D is the most used and often most confusing “Part” of Medicare. With different tiers, formulas, premiums, deductibles, copays, gaps, etc.; navigating Part D can sometimes feel overwhelming. That is why it is important to speak with a qualified Medicare sales agent that can help guide you in the process.

​How to Get Prescription Drug Coverage

Medicare drug coverage is optional and is available to everyone with Medicare. Below is information directly from Medicare.gov regarding Medicare Part D.1

​There are 2 ways to get Medicare drug coverage: 1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan. 2. Medicare Advantage Plan (Part C) or other Medicare health plan with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

​What About the “Donut Hole”?

When Medicare Part D was first implemented in 2006 there was a gap in prescription drug coverage once the initial Medicare maximum threshold was reached that caused individuals to pay full price out-of-pocket costs for prescription drugs before a higher threshold of “catastrophic coverage” was reached. This gap, seemingly in the middle of the coverage, was illustrated as a “donut hole”.

​2020 has Brought a Close to the Traditional “Donut Hole”, but a Gap still Remains

With the passage of the Affordable Care Act in 2012, the previously detrimental gap in coverage called the “donut hole” officially closed in 2020. This, however, does not mean that there is not a “gap” in the coverage. Medicare.gov describes this new gap as such:

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,130 on covered drugs in 2021, you’re in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap. 2

As stated above a gap remains, but an individual with Medicare Part D will pay no more than 25% out-of-pocket per prescription fill and some plans will offer even greater discounts within this coverage gap.

​Get Advice from a Licensed Medicare Broker

With the recent changes as well as the diverse plans and options, it is important to speak to a qualified and licensed Medicare Broker. Contact the CSG Medicare Pros. Our agents are experienced and licensed specializing in Medicare Health Insurance providing Medicare (parts A and B), Medicare Supplemental Insurance, Medicare Advantage (Part C) and Medicare Prescription (Part D) plans. We serve Medicare recipients in every county in Arizona including in the cities of Phoenix, Mesa, Tempe, Chandler, Apache Junction, Gilbert, Tucson, Kingman, Bullhead City, Prescott, Flagstaff, Yuma, Sierra Vista and more. CSG Medicare Insurance Agents are independent, licensed and appointed with multiple insurance carriers to give you a wide variety of choice. For more information, call (480) 635-4050 or (928) 263-8500.

Sources:
1. https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage
2. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap
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