Understanding Medicare Part D Costs
Reviewed by: Brett Braithwaite, Licensed Insurance Agent
The cost for a Part D plan varies depending on your needs, policy, and financial assistance. The premium can range from around $30 up to $100+ depending on deductibles and drug coverage.
Your income can affect your premium, known as the income-related monthly adjustment amount (IRMAA).
If you go 63 days or more without creditable drug coverage after your Initial Enrollment Period, you may have to pay a late enrollment penalty.
Medicare Part D is a medication insurance program administered through private insurance companies. It’s essential to know Part D has:
- different levels of coverage and costs.
- a specific list of drugs available for each plan.
- a list of in-network pharmacies that you are required to use after enrollment.
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You pay a monthly premium for prescription drug coverage in addition to your Medicare Part B premium. The average Part D premium in 2023 is $32.74, though the cost can vary with different plans.
Part D costs depend on:
- The prescription drugs you need
- The plan you join
- Whether you use a pharmacy in your plan’s network
- Whether the drugs you use are on your plan’s formulary
- Whether you’re eligible for Extra Help (a financial assistance program)
Other costs to consider:
- Medicare Part D monthly premiums
- Medicare Part D annual deductibles
- Copayments or co-insurance
- Late enrollment penalty
Your income plays a role in determining your Part D premium. You’re required to pay more for your prescription drug plan if you made more than $97,000 as an individual or $194,000 as a couple when filing your most recent tax return. The calculation is known as the income-related monthly adjustment amount (IRMAA).
The IRMAA rates for 2023 are listed below:
- Individual: Up to $97,000
- Joint: up to $194,000
- You pay (in addition to premium): $0
- Individual: $97,001-$123,000
- Joint: $194,000-$246,000
- You pay (in addition to premium): $12.20
- Individual: $123,000-$153,000
- Joint: $246,000-$306,000
- You pay (in addition to premium): $31.50
- Individual: $153,000-$183,000
- Joint: $306,000-$366,000
- You pay (in addition to premium): $50.70
- Individual: $183,000-$500,000
- Joint: $366,000-$750,000
- You pay (in addition to premium): $70.00
- Individual: $500,000 and above
- Joint: $750,000 and above
- You pay (in addition to premium): $76.40
Are you eligible for cost-saving Medicare subsidies?
Medicare Part D plans have different levels of “tiers,” which determines the cost of certain prescription drugs on the plan’s formulary list. Medications that fall into the first tier have the lowest copays or copayments. The price goes up with each tier.
- Tier 1 has the lowest copay for generic drugs. To receive approval from the Food and Drug Administration, generic drug makers must prove that their product performs the same way as the corresponding brand name drug. Generic drugs use the same active ingredients as brand name drugs to achieve desired results.
- Tier 2 has a medium copay for preferred brand name drugs. Preferred brand name drugs are medications manufactured by one manufacturer that are typically lower-cost among all brand name drugs. This is partly because these medications have been in the market for some time and are widely accepted).
- Tier 3 has a higher copay for preferred brand and non-preferred brand name drugs. Non-preferred brand name drugs, on the other hand, tend to cost more because they are new to the market. You may have heard the term “designer drugs.” These high-cost drugs fall into the same category.
- Tier 4 has a higher copay for non-preferred brand drugs and non-preferred generic drugs.
- Tier 5, or the Specialty Tier, has the highest copay. It contains very high cost brand and generic drugs, which may require special handling and/or close monitoring.
What extra benefits and savings do you qualify for?
Medicare Part D Payment Stages
There are four stages of costs for Medicare Part D. You’re responsible for paying different amounts in each stage.
- Stage 1 annual deductible
- Stage 2 initial coverage
- Stage 3 coverage gap, or “donut hole”
- Stage 4 catastrophic coverage.
You should be aware of Medicare Part D’s lifetime late enrollment penalty if you miss the Initial Enrollment Period. The penalty applies if you go for more than 63 days after your Initial Enrollment Period without creditable drug coverage.
The late enrollment penalty cost is calculated by Medicare when you enroll in a Part D plan. To calculate the penalty, multiply 1% of the yearly average premium (which is $32.74 in 2023) by the number of eligible months you did not have Part D insurance. Then, you round to the nearest ten cents.
Example: Let’s say your Initial Enrollment Period ended March 31, 2020. You waited until December 2022 to join a Part D plan during the Open Enrollment Period. Your policy went into effect on January 1, 2023, which means you went 21 months without creditable coverage.
Here’s how to calculate the penalty:
.21 (multiply 1% by the number of months you went without coverage even though you were eligible to enroll) X $32.74 (2023 average Part D premium) rounded to the nearest $0.10 = $6.90
The cost of the penalty can change if the national premium average increases or decreases. A late enrollment penalty can remain in effect as long as your Part D plan is active.
Do you have more questions about enrollment and how to avoid the penalty? Check out our guide on how to navigate Medicare Part D enrollment.
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Medicare offers a program called Extra Help to assist with Part D costs for those with limited income and resources. Extra Help is estimated to be worth $5,300 per year. If you qualify, the program helps cover your premiums, deductibles and co-insurance costs.
Extra Help Eligibility
To qualify for Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. If you’re not sure if you are eligible based on income or resources, you can apply.
Ways you can automatically qualify for Extra Help:
- You already qualify for Medicare and Medicaid
- You are enrolled in a Medicare Savings Program
- You already receive Supplemental Security Income (SSI) benefits
You’re eligible for Extra Help if both apply:
- Your resources are limited to $15,160 for individuals or $30,240 for couples. Resources include savings, investments, real estate outside of a primary residence, stocks and more.
- Your annual income is limited to $22,110 for individuals or $29,820 for couples.
How to Apply for Extra Help
If you don’t automatically qualify but meet the limited requirements listed above, you can apply for Extra Help online , by telephone (1-800-772-1213) or by visiting your local Social Security office. You will need bank account statements, investment statements, stock certificates, tax returns, pension award letters and payroll slips.