Do we need Medicare Part D?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

My husband will be getting Medicare in a few months. I think we should have Medicare as primary & GEHA, our insurance secondary. Do we also need to get Part D? Last year his out of pocket medicines cost us $1,200. He has Crohn's disease.

Expert Answers

Many people who have other health insurance that covers some drug costs find that a Medicare Part D prescription drug plan doesn't save them money. But if your husband's prescription drugs cost you $1,200 out of pocket last year even with your other insurance coverage, then getting a Medicare Part D insurance plan is probably a good idea. Most plans cost between $150 and $500 per year. Then there is usually a $275 deductible before the plan starts covering any drug costs. After that, most plans pay 75 percent of the cost of a covered drug, with you paying 25 percent until your total drug costs for the year reach $2,510. Then you have reached what's called the "doughnut hole," during which most plans stop paying until you reach a very high ($4,510) out-of-pocket total. Some plans with high premiums provide partial coverage in the doughnut hole, too.

The most important thing to check about any plan is whether the specific drugs your husband regularly takes are included in the plan's list of covered drugs, called a "formulary." If the drugs are not on a plan's formulary, the plan won't pay for them. For a more complete explanation of how Part D plans work, see the article on this web site "Medicare Part D (Prescription Drug Plans): A Beginner's Guide".