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.
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 plan.
Let us help you with your enrollment
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.
Making Part D work
Most 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 2022, you're in the coverage gap once you and your plan have spent $4,130 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 , you'll pay no more than 25% 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. Some plans may offer higher savings in the coverage gap. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.
Medicare Part D late enrollment penalty
The Medicare Part D late enrollment penalty is an additional cost on top of your monthly Medicare Part D premium. This extra charge is based on the current year’s average national Medicare Part D premium.
The Medicare Part D penalty is 1% of the average premium for every month you went without creditable drug coverage when first eligible for Medicare. The penalty is in place to encourage beneficiaries to enroll in a Medicare Part D plan if they lack creditable coverage, meaning drug coverage at least as good as a Medicare Part D plan.
When you first become eligible for Medicare, you receive an Initial Enrollment Period to sign up for Original Medicare. Once you have Original Medicare, you are eligible for Medicare Part D.
Getting financial help
Individuals with annual incomes of less than $17,820 and financial resources of less than $13,640, or married couples with incomes of less than $27,250, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
You can also call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone.
Part D costs for higher income individuals
If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain limit, you may pay a Part D income-related monthly adjustment amount (Part D-IRMAA) in addition to your monthly plan premium. This extra amount is paid directly to Medicare, not to your plan
How is the income-related monthly adjustment amount or IRMAA affected if my income goes down?
You can ask the Social Security Administration to reconsider your income-related monthly adjustment amount or IRMAA.
As noted by the Social Security Administration:
If your income has gone down due to any of the following situations and the change makes a difference in the income level considered by the Social Security Administration, contact the Social Security Administration and explain that you have new information and may need a new decision about your income-related monthly adjustment amount based on the following:
- You married, divorced, or became widowed;
- You or your spouse stopped working or reduced your work hours;
- You or your spouse lost income-producing property due to a disaster or other event beyond your control;
- You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer’s pension plan; or
- You or your spouse received a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization.
If any of the above applies to you, the Social Security Administration needs to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a Federal income tax return for the year in question, you need to show the Social Security Administration your signed copy of the return.
For 2022, your additional premium based on income is as follows:
|For 2022, your additional premium based on income is as follows:|
|Your annual income||What you pay in addition to your regular Part D premium|
|Equal to or below $91,000||Equal to or below $182,000||$0|
|$91,001 -$114,000||$182,001 – $228,000||$12.40|
|$114,001 – $142,000||$228,001 – $284,000||$32.10|
|$142,001 – $170,000||$284,001 – $340,000||$51.70|
|$170,001 – $499,999||$340,001 – $749,999||$71.30|
|$500,000 and above||$750,000 and above||$77.90|
By contacting the phone number on this website you will be directed to a licensed agent.
We are here to help you.