• Home
  • /
  • Blog
  • /
  • Understanding Prescription Drug Plans, specifically Medicare Part D plans
February 29, 2024
Prescription drugs Medication coverage Medicare coverage Drug plans Prescription drug plans Insurance for medications Medicare Part D enrollment Copayments Deductibles Formularies Preferred pharmacies Tiered coverage levels Drug list Medicare Advantage plans with Part D Late enrollment penalty Medicare Part D savings programs Low-income subsidy (LIS) Extra help Annual open enrollment period Special enrollment periods.

In the absence of Medicare Part D coverage, individuals may need to bear the entire cost of their medications at the prevailing retail rates.

Understanding prescription drug plans, specifically Medicare Part D plans, can be a bit overwhelming at first. Here's a tutorial on how to make sense of Medicare Part D prescription drug plans:

  1. Know when to enroll: You can enroll in a Part D plan either during your Initial Enrollment Period (which is the 7-month period that begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65) or during the Annual Enrollment Period (which is from October 15th to December 7th of each year). If you don't enroll during your Initial Enrollment Period and go without "Creditable Coverage" (coverage that is at least as good as Medicare's standard prescription drug coverage), you may have to pay a penalty when you do enroll.
  2. Understand the costs: Part D plans vary in terms of their cost structures. They typically include a monthly premium, an annual deductible (though some plans don't have deductibles), and copayments or coinsurance for each medication you take. You'll want to compare these costs across plans in order to find the one that best suits your needs and budget.
  3. Check the formulary: Each Part D plan has a formulary, which is a list of drugs that the plan covers. Make sure that the medications you currently take are covered by the plan you are considering. You can usually find the formulary on the plan's website or by calling their customer service line.
  4. Look for preferred pharmacies: Part D plans often have preferred pharmacies where you can get your prescriptions filled for a lower copayment. Make sure that the plan you are considering includes a pharmacy that is convenient for you to use.
  5. Understand coverage gaps: Part D plans have something called the "donut hole," which is a coverage gap that occurs after you and your plan have spent a certain amount of money on medications in a given year. During this gap, you'll be responsible for a higher percentage of the cost of your medications. However, the Affordable Care Act has helped to close this gap over time, so it's important to keep track of the plan's coverage during the gap period.
  6. Seek assistance: Medicare can be confusing, and choosing a Part D plan is an important decision. If you need help understanding the different options, costs, and benefits of different plans, you can seek assistance from Medicare itself or from an independent insurance agent or broker like Lehigh Partners Senior Benefits.

By following these steps and understanding the key elements of a Part D plan, you can make an informed decision and choose the plan that best meets your needs and budget.

Are you ready to enroll in Medicare?

Schedule an appointment with my team. We are here to assist you, address all your queries, guide you in finding a suitable Medicare plan, and ensure that you avoid any penalties.

Part D RX drug coverage bottle

Risks of Not Enrolling in a Part D Plan

When you first become eligible for Medicare, it is important to enroll in a Medicare Part D drug plan. Failing to do so can have several potential dangers, including:

  1. Late enrollment penalty: Medicare imposes a late enrollment penalty if you do not sign up for a Part D drug plan when you are first eligible and go without creditable prescription drug coverage for a continuous period of 63 days or more. This penalty is added to your monthly premium and remains in effect for as long as you have a Part D plan. The penalty amount can vary depending on the length of time you were without coverage and can significantly increase your costs over time.

  2. Limited access to prescription drugs: Without a Part D drug plan, you may face out-of-pocket costs for prescription drugs that could be significantly higher than what you would pay with coverage. This can deter you from seeking necessary medications, leading to untreated health conditions and complications.

  3. No protection against high drug costs: Medicare Part D drug plans have an annual out-of-pocket maximum limit, beyond which you typically pay only a small copayment or coinsurance for covered drugs. Without this coverage, there is no cap on how much you may have to spend on prescription medications, leaving you vulnerable to high expenses.

  4. Risk of not being able to enroll later: If you delay enrolling in a Part D drug plan when you are first eligible and then later decide you want coverage, you may have to wait until the next Open Enrollment Period to enroll. This can leave you without prescription drug coverage for an extended period of time, putting your health and well-being at risk.

Overall, not getting a Medicare Part D drug plan when first eligible can result in financial penalties, limited access to medication, higher out-of-pocket costs, and potential gaps in coverage. It is important to carefully consider your options and make an informed decision to protect your health and financial well-being.

Are you ready to enroll in Medicare Part D?

Schedule an appointment with my team. We are here to assist you, address all your questions, guide you in finding a suitable Medicare drug plan, and ensure that you avoid any penalties.

Part D RX drug coverage bottle

Get Help

Compare Medicare coverage options with the help of one of our agents:

Talk to us: (833) 265-9655 

Medicare brokers such as Lehigh Partners get paid by the insurance companies they represent. And you pay exactly the same rate for your insurance if you use a Medicare consultant (broker). There is no extra fee or cost for enrolling through a broker. You will never pay a fee for our help.

Find a Plan

Shop for coverage online. Safe, Secure, & Confidential

Call us

Call Lehigh Partners at 1-833-265-9655

Licensed insurance agents are available to help you through enrollment and beyond.

Need Help?

Get in touch with a licensed sales agent now by filling out the form - no obligations!

Medicare Checklist

Get Our FREE Medicare Checklist.

Download our complimentary Medicare checklist and conveniently access all the necessary information in one place, ensuring you never miss a crucial number, deadline, or date again.


Medicare Advantage, Medicare Supplement, Part D RX Plans

If you're approaching the age of 65 or have already reached that milestone, you've likely encountered

General Medicare information, Medicare Advantage, Medicare Supplement, Part D RX Plans

When it comes to navigating the world of Medicare and insurance coverage, it can often feel

Ready to talk to an agent about your Medicare coverage?