Prescription Drug (Part D)


The reality is that most of us will need prescription drug, if we want to live as long as we can.  That is why (because the likelihood of using prescription drug is high) Medicare makes it mandatory that you enroll into Part D, through private companies.  Failure to do so will result in a penalty.  To learn more please visit out Nebula Insurance Learning Center.

Here are some important questions:

  • Does the plan have my prescription drugs?
  • How much of the cost do I have to pay?

All plans have a “formulary”, which is a list of drugs that they will pay for on a cost-sharing basis.  Check the plan’s formulary before you enroll.

If you are already on Part D, then you know that your share of the costs can be different according to the plan that you enrolled into.  They are basically three phases:

  • Initial Coverage – In this phase, you pay out-of-pocket costs which can be up to 25% of the prescription drug cost.  You continue in this phase until the total cost of your prescriptions reach $3,300.  This is total cost (your share and Plan D share).  This amount changes yearly.
  • Coverage gap (Donut Hole) –  Once that amount has been reached, your cost-sharing can go up to 45% for brand-names and 58% for generic.  You continue in this phase, until the total cost of your prescriptions reach $4,850 for 2016.
  • Catastrophic Phase- Once you get out of the coverage gap, you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year. has developed a tool where you can find Part D Plans in your area.  Although, it is a great tool to use, make it part your research for your decision-making.  Find an Independent Insurance Agent that will personally assist you.  If something goes wrong, it is better to have that Independent Insurance Agent’s phone number that already knows you, your needs, your living situation, etc., rather than talking to someone new on the phone.

Here is the website for the Medicare Plan Finder Tool.

There is much more to Plan D, and we have a great tutorial at Nebula Insurance Learning Center.

As always you are welcome to get in touch with one of our Agents.  Call us, so we can help find you the BEST plan.  There is no charge or committment!!