Medicare Part D

Medicare Part D can be added to your Original Medicare or Advantage plan. It covers various prescription drugs in cost “tiers” to provide the most possible benefits to its beneficiaries.

Everything You Need to Know About Part D

Medicare Part D is among a few additional options for Medicare coverage, including Medicare Advantage (MA) and supplements. It can be added to Medicare Original or Advantage, and is already included in a lot of MA plans.

Your Part D options, costs, availability, and coverage depends on a few factors. These plans are offered privately, which means that plans vary. On the other hand, they are still regulated by the federal government, meaning that you will be receiving up-to-standard coverage no matter what.

Some states have certain laws regarding Medicare that will affect Part D. Also, not all plans are available in all areas, and when they are available, the cost and coverage may look different than it would in a state over. These are all things to keep in mind as you shop for a Part D plan because, when comparing options, you may be able to get a better deal with one company over another.

The Standard Costs of Part D

The Income Related Monthly Adjustment Amount (IRMAA) for Part D is based on your MAGI and tax return from two years prior. If your income is considered higher than average, you will have to pay a higher monthly premium.

Medicare Part D payments are made in three ways—monthly premiums, yearly deductibles, and copayment/coinsurance fees. These payments will vary based on the plan and company you purchase it from. Because they are offered privately rather than through the federal government, individual companies and pricing are all going to look a bit different.

How the IRMAA Affects Your Part D Premium

The IRMAA is based on your tax return and Modified Adjusted Gross Income (MAGI) from two years ago. Once this is determined, you will fall into an income bracket that will determine how much your premium increases. 
 
Because premiums vary depending on the company and plan, increases from the IRMAA are not as direct as Part B. Whatever your premium is from the company, the IRMAA will add an additional cost to it. 
 
You will fall into one of these brackets based on your single or joint income depending on how you filed. It will look something like this:
  • Filed singly at $91,000 or less, or jointly at $182,000 or less: your plan premium will not increase.
  • Filed singly above $91,000 up to $114,000, or jointly above $182,000 up to $228,000: will add $12.40 to your plan premium
  • Filed singly above $114,000 up to $142,000, or jointly above $228,000 up to $284,000: will add $32.10 to your plan premium
  • Filed singly above above $142,000 up to $170,000, or jointly above $284,000 up to $340,000: your premium will increase by $51.70
  • Filed singly above $170,000 and less than $500,000, or jointly above $340,000 and less than $750,000: your premium will increase by $71.30
  • Filed singly $500,000 or above, or jointly $750,000 and above: your premium will increase by $77.90

Can I Avoid the IRMAA?

If your tax return or MAGI have changed or are no longer accurate, you may make an appeal to lower or remove your IRMAA premium increase—say, for instance, you were divorced within the past 2 years your IRMAA was based on. Whatever the case may be, you can file an appeal very easily by submitting the Social Security Association’s Medicare IRMAA Life-Changing Event form.

Other Frequently Asked Questions About the Part D IRMAA

Can Medicare disenroll me from my Part D plan if I don’t pay the IRMAA fee? 

Yes—same if you failed to pay your Part D standard premium, your plan can be cancelled if you don’t pay the full IRMAA.

How can I pay the IRMAA Fee? Do I pay the insurance company? 

No, you do not pay the IRMAA fee with your plan’s premium. Instead, it is deducted directly out of your Social Security benefits.

Will I be charged for the IRMAA if my Part D coverage is included in my Medicare Advantage plan? 

Yes—if you qualify for the IRMAA, you still have to pay the fee for your Part D coverage if it’s included in your MA plan.

Paying for Part D Prescriptions

Basic Part D payments look the same as the other Medicare plans—you cover your monthly premium and yearly deductible, as well as some out-of-pocket coinsurance and copayment fees. However, these out-of-pocket costs are specifically structured under Part D depending on the type of drug. These costs are categorized into “tiers:”

  • Tier 1: $1 to $3 Coinsurance, Covers Preferred Generic Prescription Drugs
  • Tier 2: $7 to $11 Coinsurance, Covers Generic Drugs
  • Tier 3: $38 to $42 Coinsurance, Covers Preferred Brand Name Drugs
  • Tier 4: 45% to 50% Copayment, Covers Non-Preferred Drugs
  • Tier 5: 25% to 33% Copayment, Covers Specialty Drugs

The Dreaded Part D “Donut Hole”

Part D plans have one issue—a temporary gap in coverage commonly known as “the donut hole.” This happens after you and the plan have purchased $4,430 worth of prescriptions in 2022, and ends when you have met your out-of-pocket limit. You will typically pay 25% of the total cost of the drug in this coverage gap.

Medicare Part D Extra Help—What it is and How to Get it

For those with a smaller, more limited income, Medicare offers a Part D Extra Help program. This will reduce the overall amount you pay in premiums, deductibles, coinsurance and copayments. Typically, this is available to those who have Medicaid and Medicare at once.

To get approved for Extra Help if you have Medicaid, all you have to do is mail some proof of your Medicaid enrollment to your drug plan. If you don’t have Medicaid, you can send a variety of other proof-of-income documents to get approved, such as a Medicare purple, yellow, or green notice for Extra Help eligibility, or a notice from the Social Security office.

Get the Real-Deal with Iowa Illinois Senior Solutions—Call Today

You can waste a lot of time searching for the right Medicare help—thankfully, you’ve come to the right place. Iowa Illinois Senior Solutions will not rest until you have the Medicare coverage you need to be satisfied, happy, and ready to take on the world. To get started, call 563-579-6116, or email jon@iailsenior.com.

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