Medicare Part D Coverage - Choosing the Right Medicare Part D Plan


Medicare Part D Coverage – Who Really Needs it and How Much Will it really Cost?

Ever since it was enacted in 2006, Medicare Part D Coverage has been a confusing issue for many seniors and other Medicare beneficiaries. They understand that it provides prescription drug coverage, something that was not previously available under Medicare, but the many plans on offer and the sometimes confusing jargon that is associated with Medicare Part D coverage can be overwhelming.

What is Provided by Medicare Part D Coverage?

Medicare Part D coverage provides help with the rising cost of prescription medications. Many Medicare beneficiaries take a number of medications on a regular basis to remain as healthy as possible. The costs of these medications can be astronomical. For these individuals exploring Medicare Part D coverage options can be more than helpful, it can provide a financial lifeline.

Although they do not issue Part D policies directly, as they do with Medicare Parts A & B the government does regulate the minimum coverage that a Medicare Part D plan must offer, to ensure that those who choose to purchase Medicare Part D coverage receive an acceptable level of coverage whichever plan they choose.

According to CMS (Center for Medicare Services) in 2013 a plan may charge no more than $295 for an annual deductible and must provide up to $2,700 of initial coverage.

Are all Medicare Part D Plans the Same?

Not at all. The government does not regulate monthly premiums, so those are set at the discretion of the individual insurance company. For 2012 CMS stated that the average cost was $28 per month, lower than they projected.

The government does require certain drugs to be covered for various diseases and conditions but individual insurance companies do have a great deal of flexibility in what they include on their drug formulary, the list of drugs that an individual plan covers and the co-pay that a patient must pay for each prescription.

Who needs Medicare Part D Coverage?

For those who take prescription medication to manage a chronic condition purchasing Medicare Part D (i.e. Humana) coverage makes a great deal of financial sense. However, those who do not may want to consider purchasing a plan anyway.

Illness can strike at any time and the costs of the medications used to treat even the most common ailments can be surprisingly high. For instance Levaquin is an antibiotic commonly used by physicians to treat bronchitis, a common ailment amongst the elderly which strikes without warning.

The average cost of a 5 day course of the medication is $190, which can be hard for many to pay for out of pocket. Purchasing Medicare Part D coverage can guard against these kinds of unpleasant financial surprises.

How much Coverage do you Need?

How much coverage you need really does depend upon the individual, their health and their subsequent requirements. The most important thing to take into account is whether you are likely to hit the ‘Donut Hole’ in Medicare coverage, whereby once you reach a threshold of $2,700.00, you are eligible to pay all your prescription drug costs until you reach $6,154.00. After that cover will begin once more.

Good gap insurance will cover you in this instance - at a price - but there are other ways to avoid the dreaded Donut Hole. A discussion of your finances with your doctor (doctor-patient confidentiality applies) should help you find ways to cut down on medical expenses.

Generic drugs are made to the exacting same standards as their more expensive alternatives – by law – but usually come at a greatly reduced price. Your doctor will advise you as to the use of generic drugs to cut down on out-of-pocket costs and hopefully avoid the coverage gap altogether.

Medicare D: Statistically the Most Useful Medicare Plan

If you are over the age of 65, you will need to purchase prescription drugs at some point. Last year twenty six percent of Medicare Part D supplemental insurance subscribers claimed over $2,700.00 worth of prescription drugs. With over a quarter of all beneficiaries hitting the Donut Hole, you can well imagine how much the average person spends and how much Part D coverage can save you. Talk to your friendly, licensed insurance agent if you require further information on Medicare Part D Cover.