MEDICARE PART D

   There are 2 ways to get prescription drug coverage through Medicare, either by a stand alone Drug plan or through a Medicare Advantage plan with drug coverage.  To get Part D you must have and/or be eligible for Part A and B.  Prescription drug plans cover drug purchased through a retail pharmacy or mail order pharmacy.

   Like Part B, there is a penalty for not taking Part D when first eligible.  That penalty is 1% per month you go w/o a drug plan until you enroll in one for the average cost of a drug plan (Approx. $40.00 monthly).

**Example not enrolled for 12 months .40 x 12 = $4.80.** Also, the IRMAA applies to Part D as well.

   All Part D drug plans have to follow rules set by Medicare.  Drug Plans have to carry 2 drugs minimum in each family of their formulary for a particular condition.  All Part D plan are subject to various "Enrollment Periods"  

   Every drug plan works on a tiered system of pricing there are up to 6 tiers to drug plans available in our area.
  1) Tier 1 is Preferred Generic

   2) Tier 2 Non-Preferred Generic

   3) Tier 3 Preferred Name Brand

   4) Tier 4 Non-Preferred Name Brand

   5) Tier 5 Specialty Drugs (Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing.)

   6) Tier 6 drugs are available on select drug plans.

   The Part D annual deductible in 2026 is $615.