Medicare Prescription Drug Coverage (Part D)

Prescription drug coverage is available to everyone with Medicare and is offered by Medicare Prescription Drug plans or Medicare Advantage Plans. The Department of Insurance and Financial Services (DIFS) does not have authority over Medicare Prescription Drug plans, but DIFS does license most of the health carriers that issue Medicare Prescription Drug plans in Michigan. However, Medicare Prescription Drug plans are solely under the authority of the Center for Medicare and Medicaid Services, a federal agency. This means that DIFS does not review or approve the contract language, the list of covered prescription drugs or the rates for Medicare Prescription Drug plans.

Health carriers will offer a variety of options, with different covered prescriptions, and different costs. Medicare Prescription Drug plans are voluntary. If you want prescription drug coverage under Medicare, you must choose a plan offering the coverage that best meets your needs and then enroll. You may only join, switch or drop Medicare Prescription Drug coverage during certain times and once enrolled, you generally must stay enrolled for the calendar year starting the date your coverage begins.

If you have retiree health coverage or are covered under an employee group health plan, please watch for any information that is sent by the employer. You may not have to make any changes. If you do not understand the information you receive from your current or former employer, please contact the company's human resources department or use the contact number provided on any written communication you receive.

Medicare Prescription Drug plans will charge a monthly premium that varies by plan. This premium is in addition to the Medicare Part B premium.  Medicare Advantage Plans that include prescription drug coverage may include an amount for the prescription drug coverage in their monthly premium. 
** As of January 1, 2011, the amount you pay for Medicare Prescription Drug coverage may be higher based on your income.**

Medicare Prescription Drug plans may have yearly deductibles that must be met before the plan begins to pay its share of your covered drugs.  *In 2016, no drug plan may have a deductible of more than $360. They may also have copayments and coinsurance that must be paid after the deductible has been met. Medicare Prescription Drug plans also have a coverage gap commonly known as the “donut hole.”  This means after you and your Medicare Prescription drug plan have spent a certain amount of money, you then have to pay all of the out-of-pocket costs for your prescriptions up to a yearly limit.  As of 2016, if you reach the coverage gap or “donut hole” in one year, you will get a 55% discount on covered, brand name prescription drugs.  The Affordable Care Act will reduce the coverage gap in Medicare Prescription Drug plans over the next ten years. There are additional savings each year in the coverage gap through 2020 when the coverage gap will be eliminated.

MEDICARE PRESCRIPTION DRUG PLAN INFORMATION:

OTHER RESOURCES:

Michigan Medicare Medicaid Assistance Program
DIFS Medicare Page
DIFS Medicare Supplement Page
DIFS Medicare Advantage Page