Medicare Part D is private health insurance designed to help Medicare beneficiaries cover prescription drugs. Costs for each Medicare Part D Prescription Drug Plan vary, but most require you to a pay a monthly premium, annual deductible, and copayments or coinsurance.
How much are Medicare Part D premiums?
Premiums for Medicare Part D (prescription drug coverage) vary by plan as well as by carrier and location. In addition, a Medicare Part D plan may change its premium each year based on inflation and estimated cost increases. According to U.S. News & World Report, about 44% of Medicare beneficiaries will pay $1 to $10 more per month if they don’t switch Medicare Part D plans in 2016. Given this situation, the most affordable Medicare Part D plan for you last year may not be the right plan for you this year. Note that the Centers for Medicare and Medicaid Services (CMS) calculates the Medicare Part D base premium at $33.13 in 2016. This amount also varies depending on your annual income.
If you’re enrolled in a Medicare Part D Prescription Drug Plan, you may qualify for a low-income subsidy, also called the Extra Help program. To be eligible for the Extra Help program, you need to reside in one of the 50 United States or the District of Columbia and have limited resources ($13,440 for an individual, $26,860 for a couple) and a limited annual income ($17,235 for an individual, $23,265 for a couple). In such a case, you can receive help with your monthly premiums, annual deductibles, and prescription copayments.
You can apply online at www.socialsecurity.gov/extrahelp or call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). Social Security representatives are available Monday through Friday, from 7AM to 7PM.
What other costs do Medicare Part D plans have?
A standard Medicare Part D Prescription Drug Plan includes a certain period of time in which you are responsible for covering 100% of your drug costs, until the deductible amount is satisfied. The standard Medicare Part D deductible amount decreased to $320 in 2016, from $310 in 2015. This is the maximum amount that you will have to cover out-of-pocket before the plan begins coverage. After you spend an amount equal to the deductible, you will pay a copayment (or a coinsurance fee representing a percentage of the drug’s full price) for a covered drug. Some Medicare Part D drug plans waive the deductible or reduce it to a lower amount.
The most affordable Medicare Part D Prescription Drug Plan for you may not necessarily be the plan with the lowest monthly premium, since a drug plan may also involve deductibles, out-of-pocket expenses for drugs, and the coverage gap, also referred to as the “donut hole.” In 2016, the coverage gap begins at the standard initial coverage limit of $2,960, a decrease from $2,850 in 2015. This amount may change each year. In 2017, for example, the coverage gap begins after you and your plan have spent $2,960 on covered prescription drugs. In 2016, after you reach $2,960, you’ll pay 45% of the plan’s cost for covered brand-name prescription drugs. Note that in 2016, 97.5% of the cost of your prescription drugs will count as out-of-pocket costs, helping you close the coverage gap. Also note that in 2017, your share for covered prescription drugs decreases to 45%.
How to compare Medicare Part D plans
You will want to compare annual Medicare Part D drug coverage costs (including premiums, deductibles, and out-of-pocket expenses) among the various plans available in your area. By evaluating all of your medication-related spending, you can make a more informed choice on what Medicare Part D plan may be right for you.
To compare Medicare prescription drug plans, you can:
- Contacting a Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contacting a licensed insurance agency such as PlanPrescriber’s parent company, eHealth.
- Calling eHealth agents at 1-888-323-1149 TTY users 711; Mon – Fri, 8am – 8pm ET.
- Or entering your zip code where requested on this page to see a quote.