Medicare Part D

Are you looking to supplement your Medicare with prescription drug coverage? One key item missing from Original Medicare is its lack of coverage for medications, especially when a large portion of its demographic is known to be dependent on daily prescriptions. Luckily, Medicare has a separate plan called Part D or Prescription Drug Plans (PDPs). Let’s explore how it works.

What Is Part D?

Medicare Part D offers coverage for prescription drugs, which each plan has the liberty to cover as it chooses. All plans cover nearly all drugs in six categories: anticancer, anticonvulsants, antidepressants, antipsychotics, antiretrovirals, and immunosuppressants. For the most commonly prescribed categories of prescription drugs, each plan covers at least two drugs.

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Which Drugs Are Covered?

Each plan chooses which drugs to cover, whether these are generic or name-brand. The plan’s covered drugs are presented in a list called a formulary. This formulary will include both generic and name-brand drugs. The drugs are sorted into tiers based on the copayment asked of you when you go to refill the prescription at the pharmacy. Generic drugs are in lower tiers, with correspondingly lower copayments. Brand-name, non-preferred, and special drugs are in higher tiers with more expensive copayments.

If you need a prescription drug that is not listed on your plan’s formulary, you and your prescriber can request an exception. You can also do this if you require a higher quantity than your plan allows.

In the event that your plan is making a change affecting your current prescription, you will receive notice 30 days before the change is in place. If the change is immediate, you will be supplied with a month’s worth of prescription when you refill at the pharmacy. These changes may be to which drug is covered, a switch to a generic brand, removal of the drug from circulation in response to FDA regulations, or simply a change in price, in which case you will receive one more month at the prior price. You do not need to worry about going without your medication as a result of changes.

Each fall, your plan will send you a letter called its Annual Notice of Change. This makes you aware of any changes to your plan, including changes to covered drugs or prices. This falls conveniently before the Annual Election Period, which lasts from October 15 to December 7. During this time you can change your Medicare plan. It is a good idea to make sure your prescription drugs will still be covered by your plan, or to switch to a different plan that will be covering them.

For all of your Medicare questions, reach out to Vickery Medicare.

Anticipated 2023 Updates

The Centers for Medicare & Medicaid Services (CMS) announced that the average basic monthly premium for standard Medicare Part D coverage is projected to be approximately $31.50 in 2023. This expected amount is a decrease of 1.8% from $32.08 in 2022.

The maximum deductible for drug coverage under Medicare will increase to $505 for 2023, up from $480 this year.

Part D donut hole no longer exists, but a standard plan’s maximum deductible will increase to $505 in 2023, and the threshold for entering the catastrophic coverage phase (where out-of-pocket spending decreases significantly) will increase to $7,400.

Inflation Reduction Act will ensure that Part D enrollees no longer have to pay for covered vaccines, and will have access to insulin for no more than $35/month.

The chart below shows your estimated drug plan monthly premium based on your income. If your income is above a certain limit, you’ll pay an income-related monthly adjustment amount in addition to your plan premium.

The income brackets for high-income premium adjustments for Medicare Part B and D start at $91,000 for a single person, but this threshold is expected to increase to $97,000 or $98,000 in 2023.