Part D Prescription Drug Plans

Unlike Medicare Advantage or Medicare supplement plans, you are only required to have Part A OR Part B of Medicare, to enroll in a "Stand Alone" prescription drug plan.  

You may enroll in a Part D plan during your "Initial Enrollment Period" 3-months prior to turning 65, and 3-months after your birth month, during the "Annual Election Period" from October 15th - December 7th, and under certain circumstances during the "Open Enrollment Period" between January 1st and March 31st. There are other opportunities to enroll in a Part D plan during a "Special Election Period".  

It's important to enroll in a plan when first available to avoid a penalty. If after enrolling in Part A or B of Medicare you do not have "creditable coverage" or a drug plan equivalent to a Part D plan you will be assessed a premium surcharge or penalty for every month you could have had a plan but did not. Unfortunately, once assessed, the penalty is permanent and will continue regardless of your enrollment in a "Stand Alone" prescription plan or a Medicare Advantage plan.  

Understanding Part D

Medicare Part D is a fairly new benefit.  It went into affect on January 1, 2006. Although it was Medicare (CMS) that designed and structured Part D it is private insurance companies who sell and manage the plans.

There are four levels to Part D

  • Deductible
  • Initial Coverage Amount
  • Gap (Donut hole)
  • Catastrophic  

In 2020 the deductible is $435, there are several Part D plans that do not have a deductible and offer first dollar coverage. The initial coverage amount is $4,020. The retail cost of your medications will determine when this amount has been exhausted (used up) at which time you would enter into the GAP "donut hole".  The maximum amount you pay for your medications while in the gap is 25% of the retail cost. On rare occasions Medicare beneficiaries enter the catastrophic stage of Part D. Designed as a "safety net" for those with very expensive and specialized medications, this level will pay up to 95% of the cost for all medications once a $6,350 TROOP (True Out Of Pocket) expenditure has been met. 

Choosing a plan

It pays to review your Part D coverage every year, especially if there were changes made or new medications added during the year.  

  • Start at Medicare.gov. You can find the basics about the benefit and Part D plans at Medicare's website. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year

Call us to help you understand your options.

Getting financial help

Individuals with annual incomes of less than $18,735 and financial resources of less than $12,890 or married couples living together with incomes less than $25,365, and resources less than $25,720 may qualify for "Extra Help" from the Federal government to help pay their Part D premiums, deductibles, co-pays and penalty if one had been assessed.

Call us at TRB Insurance to see if you qualify, and to help you complete the application.


Download Medicare's instructions on applying for the Extra Help program.

Additionally, read about the six ways to lower your drug costs on Medicare.gov.

This information was obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.  (602) 758-8998

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