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Who pays for Medicare Part D?

Generally speaking, you as an enrollee are responsible for the costs associated with Medicare Part D, including monthly premiums, an annual deductible (if your plan has one), copayments or coinsurance, and any additional fees you may owe due to late enrollment or a Part D-IRMAA charge. You can arrange to have things like your Part D premiums billed directly to you or automatically withdrawn from your Social Security or similar benefits. In some cases, your Part D premiums may be paid for by an employer or a third party such as a teacher’s union or a retirement system. It is important to note that not all of the payments associated with Medicare Part D go to the same source. For example, Part D-IRMAA payments must be sent to Medicare itself while premiums and late enrollment penalties are paid to your plan provider. Be sure to keep careful track of which payments you owe and who they need to be sent to.

Extra Help

If you meet certain requirements regarding resources and income, you may be eligible to receive Extra Help from Medicare. This program helps cover the costs of Medicare Part D, including premiums, deductibles, and coinsurance. In 2019, those receiving Extra Help will pay no more than $3.40 for each generic drug and $8.50 for each brand-name drug. To qualify for Extra Help, an individual must have no more than $18,735 in yearly income and $14,390 in resources (including money in checking or savings accounts as well as stocks and bonds). A couple must have no more than $25,365 in yearly income and $28,720 in resources. Those who have full Medicaid coverage, receive Supplemental Security Income (SSI) benefits, or get help with their Part B premiums from their state Medicaid program (through a Medicare Savings Program) will qualify for Extra Help automatically, though this qualification may change from year to year. You can apply for Extra Help through the Social Security website or over the phone. Even if you are turned down when you first apply, you can try again at any time should your situation change.

Other Kinds of Financial Assistance

Not everyone will qualify for Extra Help, but you may still be able to get assistance through other sources. Many states offer programs that help low-income residents pay premiums and other costs associated with prescription drug coverage. Contact your local Medicaid office or your State Health Insurance Assistance Program (SHIP) to learn more about the programs available in your area. Some pharmaceutical companies also offer help paying for their products. A handy tool for seeing whether assistance programs are available for your prescriptions can be found on the official Medicare website at www.medicare.gov

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