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Learn about Medicare Drug Plans (Part D)

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Medicare Health Insurance

You can enroll in a Medicare Drug plan when you first become eligible for Medicare.

Your Initial Coverage Election Period (ICEP), is a seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65 and ends 3 months after the month you turn 65.

Learn about Medicare Part D Drug Plans

The Basics

Medicare Prescription Drug Plans are available from private insurance companies contracted with Medicare to provide and coordinate prescription benefits to beneficiaries. As a Medicare beneficiary, there are two ways for you to get prescription drug coverage (Medicare Part D): through a stand-alone Medicare Prescription Drug Plan, if you have Original Medicare, or through a Medicare Advantage Prescription Drug plan.

Because these plans are offered by a Medicare-approved private insurance company, this basically means that each Medicare Prescription Drug Plan will provide different types of prescription drug coverage. It's the insurance company that ultimately decides which drugs to cover under its prescription drug plan and at what benefit level.

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The Donut Hole

Most Medicare Part D Prescription Drug Plans have a coverage gap, sometimes called the Medicare "donut hole." This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain out-of-pocket limit. The yearly deductible, coinsurance, or copayments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium.

There are Prescription Drug Plans that offer some coverage while you're in coverage the gap; some plans provide coverage for generic drugs, for example. However, plans with gap coverage may charge a higher monthly premium. Check with the Prescription Drug Plan first to see if your drugs would be covered during the coverage gap.

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Extra Help

People who get Medicare Extra Help to pay drug costs won't have a coverage gap and will pay a small or no copayment once they reach catastrophic coverage. Extra Help is a special part of Medicare prescription drug coverage that gives more assistance to people with limited incomes than the regular program does.

Qualifying for Extra Help can save a lot of money. If you qualify for "full" Extra Help, you receive coverage throughout the year (no coverage gap) and pay very little for your prescriptions. If you qualify for "partial" Extra Help, you receive coverage throughout the year and pay a reduced premium and deductible and up to 15% of the cost of your drugs.

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Some of the Companies we Represent

UnitedHealthcare Medicare Solutions
Aetna Medicare
Humana Medicare
Silver Script Part D Plan
First Health Part D Drug Plans

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