What is Medicare Part D?

Medicare Part D is a CMS-Medicare required prescription drug benefit program offered only by private insurance companies that are approved by Medicare. The program was created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and became effective in 2006. Medicare Part D is designed to help Medicare beneficiaries pay for their prescription drug costs. Medicare Part D plans cover both brand-name and generic prescription drugs and are available to anyone who is eligible for Medicare.

To enroll in a Medicare Part D plan, you must have Medicare Part A or Part B and live in the service area of the plan. How do you get Part D Prescription Drug coverage.

Each Medicare Part D plan has a formulary, which is a list of prescription drugs that are covered by the plan. The formulary is organized into tiers, with each tier having a different cost-sharing arrangement. Beneficiaries pay a monthly premium to enroll in a Medicare Part D plan, as well as copayments or coinsurance for each prescription drug they receive.

Here are some key details about Medicare Part D:

1. Coverage for prescription drugs: Medicare Part D coverage for prescription drugs provides coverage for prescription medications. This coverage includes both brand-name and generic drugs that are approved by the Food and Drug Administration (FDA). The specific drugs covered can vary depending on the formulary (list of covered drugs) of the Part D plan you choose.

2. Enrollment: Enrollment in Medicare Part D is optional only in the sense that the Medicare-eligible beneficiary has the option of staying with an employer-based creditable prescription drug plan that is as least as comprehensive as the standard Part D formularies published by the Center for Medicare and Medicaid Services (CMS).

3. To be eligible for Part D, you must be enrolled in Medicare Part A or Part B. You may enroll in a Part D plan during your Initial Enrollment Period (when you first become eligible for Medicare), the Annual Enrollment Period (October 15 to December 7 each year), or a Special Enrollment Period (for certain qualifying circumstances).

4. Creditable prescription drug plans Creditable Drug Coverage are included in some Medicare Advantage plans. Medicare Part D plans are also available as standalone prescription drug plans (PDPs) that can be used in combination with Original Medicare (Parts A and B).

5. Cost-sharing: Medicare Part D plans involve cost-sharing, which includes premiums, deductibles, copayments, and coinsurance. Each Part D plan sets its own cost-sharing structure, and the specific costs can vary depending on the plan and the medications you need. It's important to review the plan's details to understand the specific cost-sharing requirements.

Get FREE help with Medicare plans and comparisons!
No Charge, No Obligation! Call us anytime!

CALL NOW!  813-777-8056

6. Coverage gap (donut hole): In the past, Medicare Part D used to have a coverage gap, commonly referred to as the "donut hole", Medicare PART D Prescription Drug Coverage Gap where beneficiaries had to pay a larger share of their drug costs. However, the coverage gap has been gradually closing, and as of 2021, beneficiaries should pay no more than 25% for both brand-name and generic drugs while in the coverage gap. The gap will continue to decrease until it is fully closed by 2024.

7. Cobra: There can be justifications for you to enroll in Medicare prescription coverage in addition to or instead of COBRA. When COBRA expires, you will have a special enrollment opportunity to enroll in a Medicare drug plan without paying a penalty if you accept COBRA Cobra and Part D and it includes creditable prescription drug coverage.