Medicare Part D

Medicare Part D provides prescription drug coverage and will cover most, if not all, of the drugs listed in these categories: immunosuppressants, anticancer, antipsychotics, anticonvulsants, antidepressants, and HIV/AIDS drugs. Each Part D plan will have a formulary listing which specific drugs are covered.

These plans can also be used as standalone plans with Original Medicare, or as added benefits with a Medicare Advantage plan.

Most Medicare drug plans are categorized into different levels or “tiers” based on formulas that vary depending by the plan and provider you choose. But generally, drugs in each of their ‘tiers’ have a different cost. For instance, drugs in the lowest tier will cost less than those in one of the higher tiers. 

These are the 5 tiers:   

  • Tier 1: Lowest co-payment plan, Mostly Preferred Generic Drugs
  • Tier 2: Lowest co-payment, Non-Preferred Generic Drugs
  • Tier 3: Medium co-payment, Preferred Brand-Name Prescription Drugs
  • Tier 4: Higher co-payment, Non-Preferred Brand-Name Drugs
  • Tier 5: Highest co-payment, Very High Cost Specialty Prescription Drugs 

Cost Of Part D

Besides tiers, there are other costs that should be noted when it comes to Part D. For example, the national premium for Part D as of 2021 is $30.06. However, premiums can be as low as $7 or as high as $100.

Part D also has a maximum deductible of $445.

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What Does It Not Cover?

While Part D does provide a good amount of coverage for prescriptions, there are specific drugs that it will not cover. These include:

  • Over the counter drugs
  • Fertility or erectile dysfunction drugs
  • Drugs for hair growth
  • Weight loss/gaining drugs

We Find You The Medicare Coverage You Need

For more information about Part D, get in touch with Scott Sims Insurance. We will guide you through the entire process and help you make the right decision.