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Content Overview

Medicare: Part D

Overview

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Medicare Part D covers drugs prescribed outside of the hospital setting. Medicare Part D supplements Original Medicare.

Medicare Part D drug coverage is in addition to Medicare Parts A and B and is available to everyone who has Medicare Part A and/or Part B regardless of health or income.

Medicare Part D coverage is only provided by private insurance plans that follow standards set by Medicare. To enroll in a Part D plan, you must live in the plan's service area.

Medicare drug coverage is purely voluntary for most people. You do not have to sign up for it. However, your health history has likely brought home to you how expensive drugs can be. In addition to your current needs, there is no telling what the future may bring. Unless you already have equivalent drug coverage, it is advisable to consider Medicare drug coverage. Medicare even provides financial incentive to encourage you not to wait to sign up.

If you already have drug coverage equivalent to Part D, you do not need Medicare Part D. Still, it's worthwhile to check once a year to see whether your coverage or Medicare Part D is best for you.

Each company's Part D plan differs as to what benefits they offer and at what costs. At the least, all Part D plans must have minimum benefits that are at least as good as the basic plan outlined in the Medicare law.  

Most plans have a so-called "doughnut hole." Previously, participants paid 100% of the cost of medications while in the doughnut hole. Currently, there is discount for both brand-name and prescription drugs. Under The Affordable Care Act ("Obamacare"),  the cost will gradually be reduced until the doughnut hole is eliminated. (For more information, see The Doughnut Hole (Part D Coverage Gap

  • All plans have "catastrophic coverage" above which you pay close to nothing.
  • All plans also contain their own list of covered drugs (a Formulary). Drugs not on the list are only covered if a Plan agrees with your request for the drug.

Prescriptions must be filled in a pharmacy that is in your plan's network (with a few exceptions.) Plans must offer you pharmacies within a reasonable distance from your home. Many plans also permit mail-order purchases.

Financial assistance to pay Part D costs is available.

There are tips for maximizing use of Medicare Part D. For example, you can save money by filling prescriptions on a 90 day basis.

If you are denied a service, drug or item, appeal. Follow the plan's appeal procedure. If a plan is rude or the quality of service isn't good, file a grievance. A grievance is different from an appeal. To learn how, click here. (Some situations may warrant both an appeal and a grievance).  To learn about how to file a grievance, click here.

NOTE: As an alternative to Medicare Part D, drug coverage is also available through Medicare Advantage Plans which cover both health care and prescription drugs. To learn about Medicare Advantage Plans, click here

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