Medicare Part D
Medicare 2023 Part D plans can save you money on prescription drugs. Beneficiaries with Original Medicare who have Part A or Part B can enroll in a Part D plan. Then you can get a prescription card to reduce your out-of-pocket drug costs. According to Medicare.gov , you will “disenroll from your Medicare Advantage plan and return to Original Medicare” if both of the following are true: You are in a Medicare Advantage HMO or PPO, and join a separate Medicare Part D drug plan.
Your Medicare Drug Costs
How much do Medicare Part D prescription plans cost? Your Medicare Part D drug costs in 2023 will vary based on your answers to these questions:
Does the Part D plan cover your list of prescriptions?
Which drug tiers are your prescriptions?
Which stage are you in, such as have you met your deductible?
What pharmacy do you use? Is your pharmacy preferred or out-of-network?
Stage 1: Part D Deductible
Before your Part D drug plan pays anything, you first must pay the deductible. Stage one is paying Part D deductible, which increases by $25 from $480 in 2022 to $505 in 2023. Once you pay this initial Part D deductible, you enter stage two.
Stage 2: Part D Initial Coverage
Stage two is Initial Coverage. In this stage, Medicare helps pay for your prescription drugs. Your copays and co-insurance vary and are a percentage of an approved amount. However, your out-of-pocket costs prescription drug cost will not exceed 25%. For most plans, when you spend $4,660 in total drug costs in 2023, you enter the donut hole (Stage 3: Part D coverage gap).
Stage 3: Part D Coverage Gap
Stage three is Donut Hole, also called Coverage Gap. In stage three, you pay 25% coinsurance for generic and brand-name (non-discounted cost) prescription drugs. The total amount you spend inside the donut hole increases by $350 from $7,050 in 2022 to $7,400 in 2023. Once you pay $7,400 in out-of-pocket drug costs, you enter stage four.
Stage 4: Part D Catastrophic Coverage
Stage four is Catastrophic Coverage. While inside stage four, you pay the greater of 5% prescription drug cost or $10.35 brand name / $4.15 generic. For example, if your brand name drug costs $100, you would pay $10.35. On the other hand, if your brand name drug costs $300, you would pay 5% or $15. However, if a generic drug only costs $50, you would pay $4.15.
The Medicare Part D Donut Hole
The donut hole is a coverage gap in Medicare Part D that can affect your out-of-pocket costs in 2023. You may have heard the donut hole closed on January 1, 2020. Many people were excited because they believe their drug coverage will be free. However, you still have 25% coinsurance inside the Donut Hole.
Senior Healthcare Direct Experts Can Help You
Medicare Part D plans can be confusing, and yet they are critical to get right — especially for those who need Medicare prescription coverage. Don’t make decisions you’re not sure about. Instead, let Senior Healthcare Direct provide support and guidance throughout this process. Our Medicare Plan D finder tools can help us determine the best coverage for your specific situation. That might include prescription plans for seniors that cover medications that you may need at some time in the future. Whether you are unsure what type of coverage you need or you’re unsure if you need it at all, Senior Healthcare Direct will work with you one-on-one to provide information and insights. Let our experts help you navigate all the options. We can help you with all needs, including Medicare Supplement plan D coverage questions you have.
When To Enroll In A Medicare Part D Plan?
You can enroll in a Medicare Part D Plan when you initially enroll in Medicare. Learn how to enroll in Medicare. You may be eligible to enroll in Medicare 3 months before you turn age 65. This initial Open Enrollment period includes the month of your 65th birthday and three months after the month you turned 65.
We recommend enrolling in a Medicare Part D Plan when you are first eligible to avoid late enrollment penalties. However, if you have credible drug coverage, you can postpone enrolling in Part D and avoid late enrollment penalties. For example, employer drug coverage may qualify as credible drug coverage.
How Much Are Part D Late Enrollment Penalties?
Part D late enrollment penalties accumulate at 1% per month. For example, 12 months equals a 12% late penalty. Furthermore, you will owe the late penalty every month you are in a Medicare Part D plan. It’s not a one-time penalty. You pay the late penalty every month you have a Part D Plan.
Medicare.gov calculates your penalty as follows: Multiply 1% of the “national base beneficiary premium” ($32.74 in 2023) times the number of full, uncovered months you didn’t have Part D or credible coverage.
Therefore, we recommend you find a Medicare Part D Plan when you are first eligible. To avoid accumulating a late enrollment penalty, you can sign up for an inexpensive plan.
The Cost Of Not Having Drug Coverage.
Mr. Anderson had been healthy most of his entire life, and at the time of his Medicare enrollment period, was not taking any prescriptions. The insurance agent advised him to enroll in a Medicare Part D Plan to avoid late penalties. However, Mr. Anderson decided to gamble on his good health and decided not to enroll in a Medicare Part D plan.
Mr. Anderson enrolled in Original Medicare for two years without any health issues. Then at age 67, he had a heart attack. His doctor prescribed a new heart drug, Corlanor, to treat and reduce new heart failures. The cost of this life-saving heart medication is $375 per month.
Because Mr. Anderson’s heart attack occurred on April 1, he could not enroll in a Part D Drug Plan until October 15. Furthermore, the new drug plan would not be effective until next year, on January 1. Thus, he would have to pay $375 for eight months for a total of $3,000 out-of-pocket drug costs.