What You Pay for Medicare Drug Coverage?


What You Pay for Medicare Drug Coverage

These are your annual Drug Plan Costs:

  • Monthly premium
  • Yearly deductible
  • Co-payments or co-insurance
  • Costs in the coverage gap
  • Costs if you get Extra Help
  • Costs if you pay a Late Enrollment Penalty

Your actual drug plan costs will vary depending on:

  • The prescriptions you use and whether your plan covers them
  • The plan you choose
  • Whether you go to a pharmacy in your plan’s network
  • Whether you have drug coverage on your plan’s formulary
  • Whether you get Extra Help paying your drug costs

Look for specific Medicare drug costs, and then call the plans you’re interested in to get more details.

If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare Part D coverage. You may also be able to get help from your state.

Monthly Premium

Most drug plan costs include a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium you pay to your plan may include an amount for prescription drug coverage.

Get Your Monthly Premium Automatically Deducted

Contact your drug plan (not Social Security) if you want your premium deducted from your monthly Social Security payment. Your first deduction will usually take 3 months to start, and 3 months of premiums will likely be deducted at once.

After that, only one premium will be deducted each month. You may also see a delay in premiums being withheld if you switch plans. If you want to stop premium deductions and get billed directly, contact your drug plan.

Your Monthly Premium Could Be Higher Based on Income

A small group—fewer than 5% of all people with Medicare—may pay a higher monthly premium for drug coverage based on their income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare drug coverage.

If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain limit, you’ll pay an extra amount in addition to your plan premium. Usually, the extra amount will be deducted from your Social Security check.

Contact Social Security With Questions

See Social Security’s “Medicare Premiums: Rules for Higher Income Beneficiaries.” Contact Social Security if you have to pay an extra amount to your usual drug plan costs and you disagree (for example, you have a life event that lowers your income).