Medicare Part D is an optional coverage benefit that covers prescription medications for those eligible for Medicare. In 2024, Part D-related expenses are expected to decrease as benefits increase. This means an anticipated lower average monthly premium, more coverage for vaccinations, limits on how much certain items can cost, and higher income limits for qualifying for Extra Help.
Medicare Part D is a private plan that offers coverage for prescription medications.
The average Part D premium is projected to be $55.50 in 2024 - a decrease from $56.49 in 2023.
Part D coverage includes zero cost-sharing for recommended adult vaccines, as well as capping monthly insulin costs at $35.
Comparing plans allows you the opportunity to understand the benefits for you and your family.
Medicare drug coverage is an optional benefit to those on Medicare to assist with prescription costs. To obtain this coverage, you need to join a Medicare-approved plan. These will vary in cost and may cover different drugs, which would be available on a formulary. A formulary will list the coverage details for each drug category (like antidepressants, anticonvulsants, etc.) and what prescriptions are covered under your plan.
Medicare Part D
Medicare Part D is a voluntary drug benefit that is obtained through private plans that have a contract with the government. Recipients can choose a stand-alone coverage plan or a Medicare Advantage plan that will include prescription drugs, according to their formulary. If you opt out of coverage, you may pay a late enrollment penalty. There are also Fee-for-Service plans offered and savings accounts.
Those with Part D will pay a monthly premium. Some recipients will pay premiums to the plan directly, while others may have it taken out of their Social Security checks. The premium is priced according to income, level of coverage, and the base beneficiary premium. The base beneficiary premium is a starting point for figuring costs, indicating what the expense would be for a minimal level of coverage. In 2024, the base beneficiary premium is $34.70, up from $32.74 in 2023.
Despite the slight increase in the base beneficiary premium, the average premium for Part D will be cheaper. The average Part D premium is projected to be $55.50 in 2024, which is a decrease from the 2023 average of $56.49. This is due to the premium stabilization feature of the Inflation Reduction Act, which restricts the base beneficiary premium from rising beyond 6% per year.
Part D’s cost-sharing refers to deductibles, coinsurance, or copayments, but does not include premiums or the cost of non-covered services. In 2024, the cost-sharing will be lower than in years past, as Part D policyholders are projected to save roughly 15% on out-of-pocket costs for prescription medications for the year of 2024.
Specific insulin products are capped at $35 for one month’s supply, regardless of whether you’ve met your deductible. If you haven’t met your deductible yet, your out-of-pocket payment for your insulin product will count toward it. Check your plan’s formulary to see if this cap applies to the insulin product you take.
Medicare covers all vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). Such vaccinations include Tdap (tetanus, diphtheria, pertussis) shingles, COVID, flu, pneumonia, and hepatitis B. Cost-sharing for recommended vaccines will be eliminated in 2024.
Donut hole discount
Medicare Part D policyholders who are not eligible for Extra Help or Low-Income Subsidy programs will have a 75% donut hole discount on covered medications purchased during this coverage gap. The donut hole refers to the coverage gap after you exceed your coverage limit, which is $4,660 in 2023. In 2024, you will enter the coverage gap after you and your plan have spent a combined $5,030.
Even though you get the same discount on covered brand-name and generic drugs in the coverage gap, they differ in how they count toward getting you out of it. Only the amount you pay out-of-pocket for generic medications will count toward getting out of the coverage gap. For brand-names, this will be the combined amount that the manufacturer (who covers 70% of the cost) and you (who covers 25% of the cost) pay.
In 2024, Catastrophic Coverage will begin once your out-of-pocket expenses for covered medications surpass $8,000 (up from $7,400 in 2023). Once you’ve entered Catastrophic Coverage, your cost-sharing for covered medications will be $0 for the rest of the year.
The donut hole is expected to be eliminated in 2025.
If your income is low and you meet the requirements for resource limits, you can get Extra Help, which enables you to get Part D for a $0 premium. Your coinsurance and copayment costs will be a low, fixed amount to keep your prescriptions affordable.
In 2024, the income limit for qualifying for Extra Help has increased. In 2023, qualifying for Extra Help was limited to those earning no more than 135% of the federal poverty level. In 2024, you can qualify for Extra Help if you earn up to 150% of the federal poverty level.
Medicare Open Enrollment starts October 15, 2023 and will continue until December 7th, 2023. This is the best time to compare plans and see what is best for you and your family. You can compare Medicare, Medicare Advantage, and Part D drug plans. Drug plans and coverage can change annually, so it’s best to be prepared and see what may change for you in the coming year.
To see which Part D plans are offered in your area, look on the Medicare.gov website and enter your zip code for 2024. You can also select the plan type you are looking for, such as Medicare Advantage, Part D, or Medigap only.
Knowing your options for prescription drug coverage can save you money and the hassle of guesswork. Using the Medicare website, you can compare plans in your area to see what works best for you and your family. Staying up-to-date on annual changes can assist in knowing what benefits have changed and what services or prescriptions will now be covered. If you’d like to learn more, check the Medicare website, where you can utilize a chat or contact a representative.
When will my Part D plan go into effect?
Your coverage won’t begin immediately after you join during the Open Enrollment Period. When you join a plan, your coverage will go into effect on January 1, 2024. However, you can only utilize the Open Enrollment Period if you have Original Medicare.
What if I have Medicare Advantage?
If your Medicare Advantage plan lacks drug coverage and you’d like to add Part D, you can do so during the Medicare Advantage Open Enrollment Period, which is from January 1 to March 31. Your coverage will begin on the first day of the month after you join.
Do I need to join Part D if I already have drug coverage?
You can delay joining Part D without incurring a late enrollment penalty if you already have drug coverage. As long as your drug coverage is considered creditable, you can wait to enroll in Part D without risking late enrollment fees.
- Kaiser Family Foundation. An Overview of the Medicare Part D Prescription Drug Benefit.
- Medicare.com. Did the Coverage Gap or Donut Hole just close up and go away?
- Healthcare.gov. Cost sharing.
- U.S. Centers for Medicare and Medicaid Services. Medicare.gov.