Medicare Part D: Overview

Medicare Part D is a prescription drug program subsidized by the federal government.  This program was enacted as part of the Medicare Modernization Act of 2003 and went in to effect on January 1st, 2006.

There are two types of Medicare Part D plans administered through private insurance companies: Part C health plans (MAPD) that include drug coverage and stand-alone prescription drug plans (PDP) that offer drug coverage only.

Individuals on Medicare who are eligible for Part A and/or Part B may obtain drug coverage through a plan.  Typically, individuals can enroll during their Open Enrollment Period or once a year during the Annual Enrollment Period (AEP), which is Oct. 15th – Dec. 7th.

Participation in Part D is voluntary, but most Medicare beneficiaries choose to enroll in a plan.  If you choose not to enroll, a 1% late enrollment penalty will be added to your plan premium for each month you were not enrolled in a plan.

Part D: Eligibility

Individuals who are eligible for Part A and/or Part B can enroll in a Part D prescription drug plan (PDP).  If you are eligible for Part A and/or Part B, you can enroll in a stand-alone drug plan only.  If you wish to enroll in a Part C, Medicare Advantage health plan (MAPD) with drug coverage included, you must be eligible and enrolled in BOTH Part A and Part B (A+B=C).

Drug coverage is provided through network pharmacies within the plan’s service area and you must live in the plan’s service area to obtain coverage.  Each plan has two types of pharmacies: preferred cost share and standard cost share.  Preferred pharmacies usually have lower drug co-pays than standard cost share pharmacies.

How it Works

Part D plans have four phases: deductible phase, initial coverage phase, coverage gap phase (donut hole) and the catastrophic phase.

 

Part D: We’re here to help!

Prescription drugs are by far the most concerning and most complicated aspect of Medicare.  But don’t worry, we’re here to help!  We encourage everyone to check their drug plan each year and we can walk you through that process.  Our service is FREE to you, no obligation!  Give our licensed Medicare agents a call today at 1-800-594-5393 or email us at davewind@mac.com or jonw.insurance@gmail.com.