Part D Prescription Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday, the month you turn 65, and 3 months later.  The earliest your coverage will start is the first of the month you turn 65, and then after that, the first of the month following receipt of your application.  You may also enroll by these guidelines if deemed disabled by Social Security and the eligibility dates to follow are the Parts A & B effective date of Medicare, which is 24 months after initial disability date.

It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree or group health plan.

Let Us Help You Enroll.

If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.  It is good to re-evaluate your choices annually, specifically if your medical needs and prescription drug usage has changed.  As Independent Agents, we are certified to sell various Part D plans throughout the state.

Making Part D Work

Most Medicare Prescription Drug Plans have a coverage gap called a donut hole. This means there’s a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. For 2015, you’re in the coverage gap once you and your plan have spent $2,960 on covered drugs. People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Once you reach the coverage gap in 2015, you’ll pay 45% of the plan’s cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug. 

Although you’ll only pay 45% of the price for the brand-name drug in 2015, 97.5% of the price will count as out-of-pocket costs which will help you get out of the coverage gap.

In 2015, you’ll pay 65% of the price for generic drugs during the coverage gap. What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.

Once you’ve spent $4,700 out-of-pocket in 2015, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Getting Financial Help

Individuals with annual incomes of less than $17,235 and financial resources of less than $13,300, or married couples with incomes of less than $23,265 and resources of less than $26,580, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.


Download Medicare’s instructions on applying for the Extra Help program.

Additionally, read about the six ways to lower your drug costs on Medicare.gov

By submitting your personal information you are authorizing us to contact you regarding your insurance inquiry.

Herbert Insurance Agency

115 Hanover Ave Suite 100

Ashland, VA 23005

Phone: (804) 798-4438

Fax: (804)-798-1824

Michele@HerbertInsuranceAgency.com


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