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CostHelper > Personal Finance  > Taxes & Financial Planning > Medicare Part D

Medicare Part D Cost


How Much Does Medicare Part D Cost?

 
low costLow: $0 average costAverage: $30 Per Monthhigh costHigh: $130+ Per Month
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Medicare Prescription Drug plans are also called Medicare Part D. Although these plans are approved and regulated by the federal government, they are all designed, operated and sold by private insurance companies.

Generally, Part D plans are either purchased in addition to traditional government-run Medicare (Part A and/or Part B) or as part of a Medicare Advantage (Part C) policy from a private insurance company. For an overview of all these options, see How Much Does Medicare Cost.

Typical costs:

  • The two basic expenses for Medicare Part D are the monthly premium and the cost of buying prescription medications under each plan. The specific drugs covered vary from one plan to another, or even from year to year under the same plan, which means premium costs will vary depending on which drugs are covered.
  • The average monthly premium for a Medicare Part D Prescription Drug Plan in 2014 is $31, or $372 a year, according to the Department of Health and Human Services[1] . However, premiums can cost zero to more than $100 a month and not all plans are offered in all areas. The Kaiser Family Foundation provides an overview of the 2014 Medicare Part D plans[2] .
  • Each year the government sets the minimum coverage an insurance company is allowed to offer; in 2014 this is a maximum $310 deductible, an initial coverage limit of $2,850 and an out-of-pocket threshold of $4,550. The individual pays up to the deductible amount; the Part D plan pays 75% of costs up to the initial coverage limit. The gap between the initial coverage limit and the out-of-pocket threshold is known as the "doughnut hole." Once this gap has been reached, brand-name drugs are discounted 50% by the manufacturer, the Part D plan pays 2.5% and the person pays the remaining 47.5%. For generic drugs, the Part D plans pay 28% of the cost and the individual pays 72%, until the total amount spent on prescriptions exceeds the out-of-pocket threshold. Anything above that amount is considered catastrophic coverage, and the individual pays 5% of the total prescription cost. All Medicare prescription drug coverage must be at least as good as this minimum standard. Some policies may lower or eliminate the deductible; others might reduce or eliminate the "doughnut hole" coverage gap.
Related articles: Medicare Part A, Medicare Part B, Medicare Advantage, Medicare

What should be included:
  • Medicare drug plans cover both generic and brand name drugs. However, each plan has its own formulary -- a list of prescription medicines covered under the plan. A formulary must meet Medicare's minimum requirements, but does not have to cover all prescription medications. Most formularies do not include medicines not approved by the FDA, fertility drugs or medications for weight loss or gain. The Medicare Formulary Finder[3] searches by zip code or an individual's Medicare information (name, number, etc.) for local plans that cover specific drugs.
Discounts:
  • Subsidies are available from Medicare so that low-income seniors pay no premiums or deductibles for their Part D Prescription Drug plans; medicare.gov offers a brochure[4] on applying for help paying for prescription drugs.
Shopping for medicare part d:
  • To choose the best Medicare Prescription Drug plan, make a list of all medications taken, how much the individual is currently paying for them and at which pharmacies. Use the Medicare Plan Finder[5] to enter the drug names and search for details on the Part D Prescription Drug plans available locally. The Medicare Rights Center lists questions to consider[6] when choosing a Medicare Part D Prescription Drug Plan.
  • The initial open enrollment period for Medicare Part D is the month of the person's 65th birthday, plus three months before and three months after.
  • To change Medicare prescription drug plans, the annual open enrollment period[7] is Oct. 15 to Dec. 7.
  • If a person is covered under the original government-run Medicare (Part A and Part B), signing up for some Part D prescription drug plans could trigger an automatic switch to a private Medicare Advantage (Part C) plan. Before choosing, ask if a Part D plan works with Medicare Part A and B, or is connected to a Medicare Advantage plan.
  • It's not mandatory to take Part D Prescription Drug coverage when first eligible for Medicare. However, if Part D coverage is added later the premiums will be higher unless there is proof that during the period when Part D coverage was waived the individual had other prescription drug coverage (i.e. under a spouse's health insurance) that was at least as good as Medicare Part D.
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What People Are Paying - Recent Comments
cost
Amount: $0.00
Posted by: new to medicare in spring, TX.Posted: October 10th, 2013 12:10AM
Type of Plan: part d onlyCoverage Provided: changes
Company: united health care/aarp
I have been totally "blindsided" by the whole medicare and part d process..i did research it before retirement,but I had been used to being on a ppo and having prescription drug coverage as well because I worked for a large corporation..i "prefunded" my retiree medical,but at 65 they take you off the rx program and you must get part d..also your "prefunded" medical becomes secondary to medicare..part d is not a "money saver" for seniors,rather its a "money pit" because of the "donut hole" clause! unfortunately my meds are not all generic, and even before the dreaded "donut hole",they were considerably higher, by 20-150$ more per prescription than what I had been accustomed to paying..sadly turning 65 rather than being "golden years",seems to e how much gold the drug companies can get out of you..and its ok with the government as they passed the part d bill just a few years ago..i don't remember my parents having these problems..
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External Resources:
  1.  www.hhs.gov/news/press/2013pres/07/20130730c.html
  2.  kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-plan-offerings-in-2014/
  3.  //www.medicare.gov/find-a-plan/questions/home.aspx
  4.  www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=1...
  5.  //www.medicare.gov/find-a-plan/questions/home.aspx
  6.  www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=1204#top
  7.  www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=1204#top
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