Can you help explain Medicare Part D?

1 answer | Last updated: Nov 27, 2016
Carnes asked...

Can you help explain Medicare part D such as how much it costs and where can my daughter--who is currently recieving disability--apply? Thanks.


Expert Answers

Once your daughter's been receiving Social Security disability benefits for two years, she's eligible for full Medicare coverage, including a Part D prescription drug plan. The plans cost about $10 to $75 per month, depending on the plan's coverage and where your daughter lives. A few plans have no premium at all. Plans with the broadest coverage and lowest copayments usually have the highest premiums.

With most plans, your daughter will pay a $275 "deductible" before a plan will start to cover her prescription drug costs. After the deductible, most plans pay 75 percent of costs for covered drugs. Your daughter pays the other 25 percent as a copayment for each prescription. For certain drugs, the copayment is higher. These copayments continue until her total prescription drug costs for the year reach $2,510. After that (in what's called the "dougnut hole"), the plan pays nothing more for her drugs unless and until she reaches the "catastrophic" limit of $4,050. A few high-premium plans pay some costs in this "doughnut hole." If and when your daughter's total out-of-pocket costs for prescription drugs reaches $4,050 for the year, the plan will cover 95 percent of further costs for covered drugs.

In choosing a plan, you have to consider a variety of things, the most important of which is whether your daughter's drugs are covered by the plan. To get information about Part D plans where your daughter lives, see the Medicare website. This includes the crucial information about the medications currently in each plan's list of covered drugs (called a formulary). You can also contact Medicare by phone at (800) 633-4227. Excellent independent and free expert help in choosing a plan is available from your local State Health Insurance Assistance Program (SHIP) or Health Insurance Counseling and Advocacy Program (HICAP). You can find the phone numbers under SHIP and HICAP in the white pages of your local phone directory. You can also get independent help online from the Medicare Rights Center.

Once you've narrowed your choices to a few plans, contact the plans directly to get the latest information about their coverage and costs. And when you decide on a particular plan, your daughter enrolls enroll directly with it, not with Medicare.