Medicare Part D: What Is It and Who Is It For? 

Having access to quality healthcare isn’t always easy or affordable. When working a job that doesn’t offer health insurance or that only offers high-priced, premium plans, it can be easy to think forgoing insurance is the solution.

Having insurance is vital, however, if you want to remain healthy in both the physical as well as financial sense. Even if you still feel strong and healthy, insurance is important because:

• It gives your mind rest
• Allows you to catch problems early
• Gives access to preventative care
• Makes doctor’s visits and prescriptions cheaper
• Makes emergency situations less stressful

Part D As An Option For Prescription Drugs

Medicare is a government-funded health insurance plan. It’s only available to those who are at least 65 years of age and meet certain income requirements. This government-funded insurance allows you to have coverage at a reasonable price.

Medicare plans are great for seniors on a low income who need quality health insurance coverage. There is a wide range of options available on websites like clearmatchmedicare.com, depending on your local area, income, and health history. One you may not have heard of is Part D, which can be considered Medicare’s prescription drug coverage plan. 

The Basics of Part D

Part D is only available to those who are eligible for other Medicare plans. It was designed to help pay for prescription drugs that Parts A and B don’t cover. It’s a good option to look into if you take multiple prescription medications or are prescribed name-brand pills that take up a good chunk of your monthly budget.

Though it doesn’t cover the entire cost of your prescriptions, it does cover 75 percent. You’ll still have to pay that remaining quarter, and possibly a monthly premium for the plan as well.

Part D is considered optional and actually goes through private insurance companies in order to provide you with low-cost expanded coverage. You must be under a Part A or B plan to qualify, and each part D plan will pay for different medications.

It’s important to note that enrollment is not automatic. You must apply every year between October 15th and December 7th, or risk a late application fee.

What’s Typically Covered by Part D

There are standards that most plans follow for coverage. Almost all Part D plans offer vaccines free of copay. Other than this, they typically cover at least two of the following prescription drug categories:

• Antipsychotics
• Anticonvulsants
• Antidepressants 
• Immunosuppressants 
• Cancer Medication
• HIV Medication

When you begin your plan, your medications may be covered, but Part D plans can change at any time if certain factors occur. This includes a name-brand drug getting a generic counterpart or new research coming out favoring a different treatment. Prices are also subject to fluctuation. 

What Isn’t Typically Covered by Part D

Not everything is covered by a Part D prescription drug plan. Similar to a standard health insurance plan, over-the-counter medications like vitamins and basic pain relievers aren’t included with your coverage. Certain categories of prescription drugs aren’t allowed to be covered by any Part D plan. These medications include:

• Fertility medications
• Erectile dysfunction medications
• Cough and cold medicine
• Weight management medications
• Hair growth medications and formulas

How To Qualify

Getting Part D isn’t complicated, but it’s important to follow all instructions carefully. Before starting the application process, it’s a good idea to take a look at the basic standards you need to hit in order to qualify. Any of the following will make you eligible for a Part D prescription drug plan:

• Being 65 years or older
• Have ESRD (end-stage renal disease) or kidney failure
• Have received SSD (social security disability) for 2 years minimum
• And have an ALS (amyotrophic lateral sclerosis) diagnosis and be on SSD

You can enroll in Part D at the same time you apply for Part A or B coverage. This is typically within three months in either direction of your 65th birthday, unless disability allows you to apply sooner.

You will be able to switch plans during certain times of the year if the plan isn’t suiting your prescription drug needs. These time frames are called open enrollment periods and happen twice throughout the year.

Open enrollment periods aren’t the only way you can make a Part D plan switch.  And you may also be eligible for a change in the plan if:

• You move out of the Plan D coverage area
• You move into an assisted living facility or nursing home
• Your plan doesn’t offer Plan D
• You lose coverage of essential medications
• You find a higher-rated plan

Part D Costs

The cost of your plan will depend on a number of factors that may include your local area, what medications you need to be covered, and your income. A plan will, on average, run between $10 to $100 monthly, with a few plans falling out of this range.

Part D prescription drug plans are a financially smart option for seniors already on a Part A or B plan. Take the first step and find a plan that’s right for you.

Stay Happy & Healthy!