Medicare Part D is an optional program that helps pay for prescription drugs. It does this through a variety of plans offered by private companies that have been approved by Medicare. A Medicare Prescription Drug Plan offers:
The program can dramatically reduce the cost of your medications. Remember, unless you qualify for “Extra Help,” this program is designed to share the costs with you, not pay all of your prescription costs.
Are you a healthcare provider? Read CLAIM’s Fact Sheet: Medicare Part D Information for Professionals.
Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. People can choose to join a Medicare drug plan that meets their needs based on coverage, cost, convenience, and customer service.
There are two types of Medicare Drug Plans:
Medicare Prescription Drug Plan (PDP) – These plans add drug coverage to Original Medicare (Parts A and B) and some other types of Medicare plans.
Medicare Advantage Plan (MA-PD) – This is an HMO, or PPO, or other Medicare health plan that includes prescription drug coverage. You will get all of your Medicare coverage (Parts A and B), including prescription drugs (Part D) through these plans.
All Advantage Plans must offer at least the standard level of coverage as original Medicare. Plans can be flexible in their benefit design and offer different or enhanced benefits. Their benefits and costs may change from year to year.
Medicare drug plans will cover generic and brand name drugs. To be covered by Medicare, a drug must be available only by prescription, approved by the Food and Drug Administration, used and sold in the United States and used for a medically accepted indication. Each plan will have a “formulary” that tells you which drugs are covered by the plan. Plans may require prior authorization, step therapy and quantity limits.
If you do not enroll when you are first eligible and go without creditable prescription drug coverage for 63 continuous days or more after your Initial Enrollment Period, you may have to pay a late enrollment penalty to join later. The penalty amount is based on when you join. It is added each month to your Medicare drug plan’s premium for as long as you have a plan.
Many people with limited income and resources will be eligible for “Extra Help” paying for prescription drugs. “Extra Help” is sometimes referred to as “Low-Income Subsidy ” (LIS). People with the lowest income and resources will not pay premiums or deductibles and have small or no copayments. Those with slightly higher incomes will have a reduced deductible and pay a little more out of pocket.