Medicare Part D in Massachusetts

Medicare Part D in Massachusetts

Last updated on: November 08, 2022

Medicare Part D is a federal program that became available in Massachusetts in 2006. The purpose of Part D is to provide prescription medications at an affordable rate for Massachusetts residents who are enrolled in Medicare. Before Medicare Part D was implemented, people on Medicare generally had to pay out of pocket for all prescription medications, and that can get extremely costly.

In Massachusetts, similar to a Medicare Supplement Plan, Medicare Part D is an add-on that you have to specifically choose to enroll in. It’s highly recommended that everyone take advantage of this add on because the cost of some prescription medications in Massachusetts can be very steep.

How Much Does Medicare Part D Cost in MA?

Medicare Part D has monthly premium costs just like any other insurance policy. Each insurance company sets their own rates, so it’s important for you to research and shop around a little bit to make sure you get the best coverage for the best price. Part D plans can cost anywhere from seven dollars per month in some states, to more than two hundred dollars in others.

All Part D Coverage Available in Massachusetts is Not Equal

Every insurance company that offers Part D also offers their own list of included medications and benefits. This means that you need to make sure the company you are purchasing the plan from actually covers the medications you need. Of course, you may end up needing something in the future that isn’t covered, but you’ll want to make sure that anything you are currently prescribed is covered if possible.

Massachusetts Part D Deductibles & Copays

In 2021, the maximum Part D deductible is $445, meaning you may have to pay this amount of money out of your own pocket before the plan kicks in to help cover costs for you. Different insurance companies will have different deductibles, but none of the companies are allowed to set a higher deductible than what Medicare allows. Generally speaking, the plans that have higher deductibles will have lower premiums, and vice versa.

The copays for Medicare Part D are different depending on which ‘tier’ your medication is in. There are 5 different tiers. For example, Tier 1 might be generic drugs, and Tier 3 might be brand name medications. The copay for a tier 1 generic drug will be cheaper than the copay for a Tier 3 brand name medicine. While most people are fine with the generic drugs, it’s important to keep in mind that not every prescription medication comes in the generic form. It’s also important to note that company X might charge a five dollar copay for a tier 1 drug, while company Y might charge 10 dollars. 

Every year, each insurance company publishes a large document of the medications and which tier they are placed in. It is very important to read that information carefully, especially if you are currently prescribed a large number of medications. You can analyze which medications are in which specific tiers in order to help you choose the most cost effective insurance company for your Plan D needs. 

When Do I Enroll In Medicare Part D?

There are a few different times that you can enroll in Medicare Part D.

  • When you first get Medicare

    When you first enroll in an original Medicare plan, you will have the opportunity to enroll in Part D. This is called the initial enrollment period, and it lasts 7 months. 
  • Massachusetts Annual Election Period

This period runs every year from October 15th until December 7th. You are permitted to enroll in any drug plan as well as drop any drug plan you might already be enrolled in. The prescription drug programs are allowed to change their prices every year, so it makes sense that you are permitted to change your coverage each year. If you do not explicitly request to drop this coverage, your Plan D policy will automatically renew every January.

What If I Need To Change My MA Medicare Coverage Before The End of The Year?

Medicare created something called Special Election Periods for Massachusetts residents who may need to change coverage before the end of the year. For example, if you move from MA to another state and you lose group medical coverage, you will likely be permitted to change your coverage. 

So What Exactly Does Part D Cover in Massachusetts?

A Medicare Part D prescription drug plan covers most retail prescription drugs available in Massachusetts, as well as some vaccines. Part D provides coverage for most drugs in the following categories: 

  • Anti-psychotics
  • Anti-depressants
  • Anti-convulsants 
  • Immunosuppressants
  • Cancer medications 
  • HIV/AID drugs 

While Plan D offers a lot of coverage, it’s important to know what isn’t covered. For example, in the state of Massachusetts Medicare does not require coverage in Plan D for the following medications:

  • Barbituates 
  • Cough syrups or medications to treat colds
  • Prescription vitamins 
  • Fertility or erectile dysfunction drugs
  • Drugs for cosmetic reasons, like hair or nail growth 
  • Drugs for weight loss, weight gain, or anorexia 
  • Benzodiazepines
  • Compound medications

In Massachusetts, some companies offer coverage for medications that are not required to be covered by Medicare, so choosing a Part D plan wisely can save you money.

What Are The Phases of Coverage for Massachusetts Plan D Medicare Plans?

  • Massachusetts Plan D Deductible: $445. This is the amount you have to pay out of pocket before your Plan D coverage kicks in and starts covering the costs
  • Massachusetts Plan D Initial Coverage: During this phase, you are responsible for paying your share of the prescription costs. If the plan you chose has a thirty percent copayment for prescriptions, that’s the amount you will pay, and the Plan will pay the rest. Once you reach a certain limit, you will enter the coverage gap. In 2021, that limit is set at $4,130.
  • Massachusetts Plan D Coverage Gap: Once you reach $4,130 in payments, you officially enter the coverage gap, also known as the donut hole. In this phase, you will be responsible for paying twenty-five percent for brand name drugs and twenty-five percent of your generic medication prescription costs. Once you reach your out of pocket maximum, which in 2021 is $6,550, you will move into the catastrophic coverage phase. 
  • Massachusetts Plan D Catastrophic Coverage: Once you reach this phase, your plan kicks in again and will help you with the costs of your prescription medications. You will be responsible for a small coinsurance or copayment amount for covered drugs for the rest of the calendar year. Once the new year begins, you start all over again in phase 1.

Is Plan D Right For Me?

Plan D is something that everyone who is enrolled in a Medicare plan should consider. As we age, it’s important to make sure that we will be able to receive the best care possible, and that includes accessible and affordable prescription drugs. While it may seem to increase your medical costs up front, enrolling in Medicare Plan D will almost definitely save you money in the long run. All plans are not equal, so make sure you find the one that’s best for you!


Categories: Medicare Articles, Medicare Part D
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