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Part D

Medicare Part D

Medicare Part D

Part D

Medicare Part D drug plans began in January 2006. Medicare says that they are optional but if you decide not get one you will be stuck with 1% penalty for each month you don’t have one. That means that 36 months without a Part D = 36% penalty. That penalty stays with you for the rest of your life.  Does that seem like its optional? Click Here for info in the Part D late enrollment penalty.

How to get Part D

You can either get Part D as an add on if you have Original Medicare and a supplement, or if you join a Medicare Advantage plan it will most likely have Part D. These plans are not sold by Medicare, instead there available through private insurance companies.

Where can I get my prescriptions?

These plans use contracted pharmacies so you would just need to get your prescriptions from 0ne of the network pharmacies. You will need to pay more if you use a non-network pharmacy.

Coverage limits

Every plan is different. The plans put all the medications into different “Tiers” so what your charged will be determined by which tier the medication is in. The Part D plans all have a different price for each tier and one plan may have a drug as a Tier 1 while the same drug is a Tier 2 and therefore more expensive with another provider.

How does the Donut Hole work?

In 2015 when you get to $2960 total value of prescriptions you go into the “Donut Hole” or Coverage Gap. Click Here for a more detailed explanation. Remember that you might have only paid $500 out of your pocket and your Part D will have paid the remaining $2460. The number that matters is the total retail value. Just contact us and we can break it down for you and make sure you get the plan that’s right for your situation.

Is there anything that’s not covered?

If your medication is on the Medicare Part D plans formulary then it’s covered. If not then you would need to pay the entire amount of the medication. Some plans will cover a drug while another plan may not that’s why it’s good to look at all your options.


Monthly premium can range from $15 to $188 in most counties here in California. If you didn’t enroll in Part D when you turned 65 you will have a penalty, Click Here for info. For 2015 most standalone Medicare Part D plans will have a $320 deductible. The copays for a prescription will vary based on the price for the tier it falls under.

When can I join?

The same time that you sign up for Parts A & B you’re able to join an Advantage plan with a Part D or get a separate Part D by itself. Give us a call 1-888-806-3299.

Click here to learn about Medicare Supplements

Click Here to learn about Medicare Advantage