It often seems as though nothing about Medicare is simple! Yes, the various programs can get confusing, but that’s why we strive to help you understand your plan. For example, many beneficiaries have questions about the Part D deductible. Prescription plans can indeed be complex, but here’s what you need to know.
- Medicare establishes the maximum Part D deductible each year. In 2021, it is set at $445. However, plans can set any deductible from $0 all the way up to the maximum amount.
- You must pay the full cost of many medications until you reach your deductible. But only certain drugs are subject to the deductible. Drugs are divided into tiers, with only some of them falling into this category. For example, many Part D plans offer coverage for drugs in Tiers 3, 4, and 5.
- If a particular drug is not covered by your plan, you must pay the full cost of it yourself. That amount will not be taken off of your deductible.
- Depending upon which prescriptions you have filled, you could meet your deductible all at once, or not at all in a given year. In many cases you will slowly meet it over a few months.
- After you have met your deductible for the year, you enter what is called the Initial Coverage payment stage. The plan can charge copayments or coinsurance. Costs often drop at this point.
- Each month that you fill prescriptions, your plan administrator will send you an “explanation of benefits”. This statement summarizes your prescriptions, your costs, and which payment stage you fall into during that particular month.
Whenever you have a prescription filled, pay attention to its tier according to your plan. This will help you learn whether it is a covered drug, and how it will impact your overall expenses. If you need to lower the cost of your prescription medications, compare prices at different pharmacies, accept generic drugs, and talk to your doctor about other options.
Finally, don’t just assume that the plan with the lowest deductible will be the least expensive. Consider which drugs the plan covers, and your actual cost for the year.
If you need help comparing Medicare Part D plans and deductibles, give us a call. We can help you understand your options and choose a plan that best fits your needs.