Part D is optional benefit for prescription coverage for people with Medicare A and/or B that is offered through private insurance companies that contract with Medicare
✔ It can be purchased as a stand-alone plan to accompany Medicare (with our without a Medicare supplement plan), or
✔ It may be included in a Medicare Advantage Plan
✔ If a Medicare beneficiary does not enroll in Part D when first eligible, there may be a late enrollment penalty upon future enrollment
Part D plans may charge a monthly premium and may include 4 stages of coverage: deductible, initial coverage level, coverage gap, catastrophic level
✔ Some Part D plans are contained in Medicare Advantage plans that do not charge a premium
✔ Some stand-alone plans do not charge a deductible
✔ All Part D plans provide the same benefit amount during the initial coverage period
✔ Premiums, deductibles, initial coverage amount, and out of pocket costs can change yearly
Each Part D plan has a formulary (list of drugs) that it covers
✔ Drugs, which are put into tiers, may require a prior authorization, have quantity limits or require Step Therapy (trying a less expensive alterative first)
✔ Formularies can change on a yearly basis
