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
- 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.
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