Medicare Part D Costs

All Medicare drug plans must provide at least a standard level of coverage that is set and approved by Medicare. However, all plans are not the same. Medicare Part D plans offer different combinations of coverage and cost-sharing. The following features determine the primary costs of each Medicare Part D plan:

  • Premium – The regular payment (usually monthly) you make to the insurance plan for a defined benefit period (usually a year).
  • Deductible – The fixed amount you have to pay during a benefit period (usually a year) before the insurance plan begins to pay for covered prescriptions.
  • Copayment – The fixed amount you must pay as your share of the cost for a drug. For example, your copayment might be $10 for each prescription.
  • Coinsurance - The fixed percentage you must pay as your share of the cost for prescription drugs after you pay any deductible. For example, your coinsurance might be 20%.

In addition, other factors could influence your Medicare Part D costs, depending on your individual medication needs:

  • Coverage Gap – In , if the total cost of your medications goes over the Initial Coverage limit of , you must pay of the cost of brand-name drugs and of the cost of higher cost generic drugs. The gap ends when your total out-of-pocket costs reach . Rules on the coverage gap are subject to future legal changes.
  • Higher Cost Generic Drug Cost – If appropriate for your condition, using a higher cost generic drug is usually less expensive than a brand-name drug. Typically, Medicare drug plans cover both higher cost generic and brand-name drugs.
  • Late Enrollment Penalty – The late enrollment penalty is a Medicare rule that applies to all Part D plans, regardless of provider. This penalty applies if you miss your initial enrollment period and you go 63 or more days in a row without having Part D or other creditable prescription drug coverage. The cost of the penalty depends on how long you went without the required drug coverage. The penalty is added to your premium each month for as long as you have a Medicare drug plan. If you qualify for Extra Help, you don’t pay the late enrollment penalty.
  • Financial Assistance – A program called Extra Help is a safety net to help people with limited income pay Part D costs.

Compare Blue MedicareRx (PDP) costs.

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