Medicare Part D (Medicare prescription drug coverage)
Anyone who has Original Medicare (Part A or Part B) is eligible for Medicare prescription drug coverage (Part D). Part D benefits are available as a standalone plan or built into Medicare Advantage, unless you have a Medicare private fee-for-service (PFFS) plan. The prescription drug benefits work the same in either plan. Joining a Medicare prescription drug plan is voluntary, and you pay an extra monthly premium for the coverage. Some beneficiaries with higher incomes will pay a higher monthly Part D premium. For more information, visit our webpage Medicare Premiums: Rules for Higher-Income Beneficiaries, or visit www.ssa.gov/benefits/medicare/mediinfo.html
If you don’t enroll in a Medicare prescription drug plan when you’re first eligible, you may pay a late enrollment penalty if you join a plan later. You’ll have to pay this penalty for as long as you have Medicare prescription drug coverage. However, you won’t pay a penalty if you have Extra Help or another creditable prescription drug plan. To be creditable, the coverage must pay, on average, at least as much as Medicare’s standard prescription coverage.
You can enroll during your IEP, the first time you’re eligible for Medicare. You can also enroll during the annual Medicare open enrollment period from October 15 to December 7 each year. The effective date for the enrollment is January 1 of the following year. There are also special enrollment periods for some situations.
Rules for higher-income beneficiaries
If you have higher income, the law requires an adjustment to your monthly Medicare Part B (medical insurance) and Medicare prescription drug coverage premiums. We call the additional amount the income-related monthly adjustment amount. This affects less than 5% of people with Medicare, so most people don’t pay a higher premium. If you’re single and your income is above $91,000, or married with an income above $182,000, you are considered to be a higher-income beneficiary.
Monthly Medicare premiums and costs for 2023
The standard Part B premium for 2022 is $164.90 down from $170.10 in 2022. If you’re single and filed an individual tax return, or married and filed a joint tax return, our online chart applies to you, regardless of your income. If you disagree with the decision about your income-related monthly adjustment amounts, you have the right to appeal.
While Medicare Part B is seeing a decrease in premiums next year, those who receive Medicare Part A will see increases in 2023.
Inpatient hospital deductible: $1,600 in 2023, an increase of $44 from $1,556 in 2022.
Daily coinsurance for the 61st through the 90th day: $400 in 2023, an increase of $11 from $389 in 2022.
Daily coinsurance for lifetime reserve days: $800 in 2023, an increase of $22 from $778 in 2022.
Skilled Nursing Facility coinsurance: $200 in 2023, an increase of $5.50 from $194.50 in 2022.
Monthly adjustments for Medicare Part D
Medicare Savings Programs (MSP)
If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer Medicare Savings Programs for people entitled to Medicare who have limited income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have Medicare Part A and have limited income and resources.
You can go online to get more information about these programs from Medicare’s website by visiting Medicare.gov. Find the link titled, “Get Medicare costs” and go to “Get help paying costs.” You can also read Get Help With Your Medicare Costs: Getting Started (Publication No. CMS-10126).
Only your state can decide if you qualify for help under these programs. To find out, contact your state or local medical assistance (Medicaid) agency, social services, or welfare office.
Extra Help
You may also be able to get Extra Help paying for the monthly premiums, annual deductibles, and prescription co-payments related to the Medicare prescription drug program. You may qualify for Extra Help if you have limited resources and income (tied to the federal poverty level). These resources and income limits usually change each year. You can check for the current numbers at www.ssa.gov/extrahelp
You automatically qualify and don’t need to apply for Extra Help if you have Medicare and meet one of the following conditions:
- Have full Medicaid coverage.
- Have Supplemental Security Income (SSI). 9
• Take part in a state program that pays your Medicare premiums. For more information about getting help with your prescription drug costs or to apply for Extra Help, visit us at www.ssa.gov/extrahelp You can also contact us for more information.
