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Basics of Medicare Part D individual health insurance that everyone should know about

Medicare Part D individual health insurance is a relatively new addition to Medicare program as it was introduced in 2006. This part is unique because it doesn’t cover the healthcare costs but the cost of prescription drugs that a patient has to buy.

Due to this reason, this plan is often referred to as Medicare Prescription Drugs Plan. If you already had Medicare benefits when Medicare Part D was introduced but didn’t enroll in it or are just nearing the age when you become eligible for this plan, you should know about it.

While insurance companies such as The Benefit Link will be more than happy to assist you and answer your questions regarding part D if you want a quick intro to this plan, we suggest you keep reading. Because this article will help you understand what Medicare part D is, how it works, and more.

Who is eligible for Medicare Part D offered through health insurance companies?

In short, if you are already enrolled in Medicare Part A or if you already qualify for Medicare Part B, you can automatically enroll in Medicare Part D through health insurance companies. You can get this plan as a standalone plan that facilitates your Medicare plans A and B, or you can either get it as a part of Medicare Part C. In addition to this, Medicaid beneficiaries are also eligible for Part D coverage and can enroll.

Who is running Medicare Part D plans?

While the federal government sets the basic rules and criteria for Part D, private health insurance providers or private insurance companies offer these plans. Private companies that issue Plan D set some payment terms and coverage of their programs. So if you want to enroll in Medicare Part D, you must register with a private insurance company and not directly with the government or Medicare.

What is the cost of Medicare Part D?

Keep in mind that since this plan is offered through private insurance providers, the premiums and deductibles vary greatly depending upon the specific plan provider. For instance, in 2015, the premium of plan D was $33.13 a month, increasing or decreasing depending upon several factors. For example, individuals who fall into the higher income bracket pay higher premiums than those in the lower-income bracket. Similarly, if you enroll late into Plan D, you may have to pay a higher premium for your plan—the penalty for late enrollment can be 1% of the regular premium.

What drugs are covered under Part D?

Part D covers two types of drugs that are brand or generic in each class of medicines. So, in short, if you have a specific medical condition, your plan D might cover some but not all medication available for that illness. The drugs that each Medicare Part D plan covers are listed in a formulary regularly updated each year.

So if you are using a particular drug that you want to continue using, you should check with the drug list to make sure your plan will continue to cover that medicine or not. Similarly, you may come across restrictions on the types of medicine you get coverage for, and for that reason, you may have to try less expensive drugs before moving on to expensive ones.

How much do drugs cost under Part D?

Now the cost of each drug under Part D can be complicated as you usually have to pay for 100% of the cost of drugs until your yearly deductible is met. After the deductible limit is reached, you will pay a specific portion of the cost of your medications until you reach what’s called a doughnut.

Once you reach this Doughnut stage, the part of the drug cost you have to pay increases. However, this stage also lasts up to a certain limit before you reach catastrophic coverage, where you have to pay minimal co-payment for your affordable health insurance.

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