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Medicare: Part D

Summary

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FOR ADDITIONAL INFORMATION ABOUT THE FOLLOWING SUBJECTS, SEE THE OTHER SECTIONS OF THIS DOCUMENT

Medicare Part D is stand-alone insurance that covers drugs prescribed outside of the hospital setting. Medicare Part D supplements Original Medicare.

Medicare Part D drug coverage 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 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.

Plans differ 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" during which you pay 100%of the cost of your drugs. In 2013, the manufacturers' discount on brand-name drugs in the doughnut hole is 52.5%. With generic drugs, the discount in the doughnut hole is 21%. Under Health Reform 2010, the cost will gradually be reduced until the doughnut hole is eliminated. (For more information, see Health Reform 2010.)
  • 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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