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Enrolling on time is crucial. If you delay and don't have other qualifying drug coverage, you might face a permanent penalty in the form of a higher monthly premium for your Part D plan down the road.
Even if you're already covered by a standalone Part D plan or a Medicare Advantage plan with drug coverage, you have the opportunity to switch plans during the open enrollment period every year. This window runs from October 15th to December 7th.
There are different stages in Part D coverage, each with its own associated costs:
Deductible: This is the initial amount you'll pay for covered drugs before your plan starts sharing the cost. In 2023, the standard deductible has increased slightly to $505.
Initial Coverage Phase: Once you meet your deductible, you'll enter the initial coverage phase. Here, you'll share the cost of your medications with your plan, typically following a copayment structure. The initial coverage limit has also increased for 2023, reaching $4,660.
Coverage Gap (Donut Hole): After reaching the initial coverage limit, you'll enter the coverage gap, also known as the donut hole. During this phase, you'll shoulder a higher percentage of the drug costs (typically 25% for both brand-name and generic drugs).
Catastrophic Coverage: Once your total drug costs for the year surpass a specific threshold ($7,400 in 2023), you'll qualify for catastrophic coverage. At this point, your out-of-pocket expenses become significantly lower, with Medicare picking up most of the tab.
Since your medication needs might change over time, it's wise to review your Part D coverage annually. Here are some resources to help you make informed decisions:
If you have limited income and resources, you might qualify for Extra Help from Medicare. This program can significantly reduce your Part D premiums and out-of-pocket drug costs.
Additional Resources:
Download instructions on applying for Extra Help.
Explore six strategies for lowering your drug costs on Medicare.gov.
By understanding Part D and the available resources, you can make informed decisions about your prescription drug coverage and manage these costs more effectively.
Want to Learn More?
Visit medicare.gov or call the number provided to speak with a licensed agent.