You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.
It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don't have equivalent drug coverage from another source, such as a retiree plan.
If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Part D plans have a $445 annual deductible. Some plans pay the deductible for you other plans do not.
Most Prescription Drug Plans have a coverage gap. This means there's a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. True out of pocket (TrOOP). For 2021, you're in the coverage gap once you and your plan have spent $4,130 on covered drugs. People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Once you reach the coverage gap in 2021, you'll pay 25% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.
Once your TrOOP spend reaches $6,550 in 2021, you're out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), 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. The cost will be $3.70 for generic drugs and $9.20 for brand drugs or 5% of the cost, which ever is greater.
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
Individuals with annual incomes of less than $18,735 and financial resources of less than $14,390, or married couples with incomes of less than $25,365 and resources of less than $28,720, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
Additionally, read about the six ways to lower your drug costs on Medicare.gov.