Part D - Prescription Drug Plan


“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.”

What is Medicare Part D?

Medicare Part D is a federal prescription drug plan administered through private insurance companies. Medicare beneficiaries can enroll in a standalone Part D drug plan that either supplements their Original Medicare or they can choose a Medicare Advantage plan that also features prescription drug coverage.

A Part D plan is insurance for necessary prescription medication. You pay a monthly premium to an insurance company for your Part D plan and Durham’s Medicare prescription drug experts at ClearBenefits Group LLC can help you find a plan with a premium that works for your budget. There is a copay or percentage cost to you, but the insurance company will pay for part of your prescription medication. You will receive a separate Part D insurance card that is separate from your other Medicare-related cards.

Medicare Part D Plans in Durham, NC

Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $480 in 2022. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage. The ClearBenefits Group LLC team based here in Durham, NC knows Medicare prescription drug plans well and can help you select the one that has the right deductible for your needs.

Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2022, the initial coverage cap is $4,430. After you and the insurance company together have paid this amount, then you enter the coverage gap.

The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $7,050 out of your own pocket in 2022.

Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.

Medicare Part D

What's Covered

Each Medicare Part D plan has a formulary — a list of medications it covers. Medicare requires the plan must offer at least two drugs in each class. Also, each plan cover all — or nearly all — prescription drugs in these classes:

Anticonvulsants Immunosuppressants
Anti-cancer medications
HIV/AIDS drugs

Part D plans also cover common vaccines to prevent illness.

What's Not

Prescription drug plans do not cover any medications Original Medicare covers for you. Other than that, there are a few medications that Part D will not typically cover including:

Weight loss or weight gain drugs
Fertility medication
Over-the-counter medication Erectile dysfunction medication
Cosmetic drugs

Our team can work with you to find a Medicare Part D prescription drug plan carrier in Durham. NC that offers these medications, but it is not the norm. The above list is not a complete one. If you do feel you need a drug that is not on a formulary you would like to be on, you have the right to ask for an exception.

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