Part D Prescription Drug Plans
You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday, or if you are under 65 and eligible for Medicare.
It's important to do this on time because there' may be a permanent premium surcharge for enrolling after your initial enrollment period if you don't have equivalent drug coverage from another source, such as a retiree plan. The surcharge or Late Enrollment Penalty (LEP) is approximately $0.34/mo/mo. That is, for every month you should have drug coverage and did not, you'll be charged $0.34 monthly for the rest of your life or as long as you are enrolled in Part D benefits.
Let us help you with your enrollment
If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Making Part D work
In 2024, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will increase by $600, from $7,400 to $8,000 in 2024. This will drop to $2,000 in 2025.
You will also face higher out-of-pocket costs in 2024 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $505 in 2023 to no more then $545 in 2024 and $590 in 2025, while the initial coverage limit is increasing from 4,660 in 2023 to $5,030 in 2024, and again, dropping to $2000 in 2025.
For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs. Manufacturers provide a 70% discount on brands and plans pay the remaining 5% of costs for brand name drugs. Plans pay the remaining 75% of generic drug costs. The Coverage Gap has been eliminated in 2025; details about Manufacturers participation in 2025 is known but lacks detail in several areas.
Also in 2025, beneficiairies will have access to the Medicare Presciption Payment Plan (M3P) allowing them to spread their out of pockets costs equally over the remaining months in year. Geared toward individuals whose prescription costs near or exceed the $2,000 cap early in the year; as example, a beneficiary hitting the cap in January can pickup their first refill and be billed by their Part D plan. in 12 monthly installment payments of approx $167 to cover their $2000 capped expense. The M3P plan is administered by the Part D plan. An individual defaulting on their monthly payment obligation would be terminated from the M3P plan and required to pay all remaining co-pays at checkout.
Choosing a plan
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year
Call us to help you understand your options.
Getting financial help
Individuals with 2024 annual incomes of less than $22,590 and financial resources of up to $17,220, or married couples with incomes of less than $30,660 and financial resources of up to $34,360, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
See Medicare's instructions on applying for the Extra Help program.
Additionally, read about the ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
By contacting the phone number on this website you will be directed to a licensed agent.