Medicare Part D

WHAT IS MEDICARE PART D?

Part D focuses on the medications prescribed to you. You must enroll in Part D separately, and it does not automatically come with your other Medicare policies unless you have Medicare Advantage.

You can get Medicare Part D during the Initial Enrollment Period (the three months before your 65th birthday to the three months after) or the Open Enrollment Period (October 15 to December 7).

WHAT DOES MEDICARE PART D COVER?

Medicare Part D is required to offer coverage for at least two prescription medications in the six medication categories:
● Antidepressants
● Anticancer
● Immunosuppressants
● HIV/AIDS medications
● Antipsychotics
● Anticonvulsants

The list of all of the medications covered constitutes the formulary.

The amount you pay relates to the tier your medication is in. There are four tiers: Tier 1, 2, 3, and the Specialty Tier. These range from lowest to highest copayments. The type of medication determines tiers.

Tier 1 medications are the majority of generic medications that won’t cost you as much in copayments.

Tier 2 medications cost more than Tier 1, but not as much as Tier 3 or the Specialty Tier. Tier 2 prescriptions are typically brand-name and preferred medications.

Tier 3 has the second-highest copayment. Again, these are brand-name medications that are not preferred.

The Specialty Tier has the most expensive copayments. These are medications that cost the most.

WHAT DOES MEDICARE PART D NOT COVER?

● Any cosmetic treatments, such as weight loss drugs

● Medications for fertility or erectile dysfunction

● Multivitamins, cough medicines, and benzodiazepines

For more information about what prescription drug coverage you can get with Medicare Part D, contact our Medicare Specialist today.