Medicare Prescription Drug Coverage
Medicare Part D — Medicare Prescription Drug Coverage
Medicare Prescription Drug Plans are approved by Medicare and designed to cover your outpatient and maintenance prescription drugs. It enhances your Original Medicare and/or Medicare Supplement Insurance Plan coverage. Even if you don’t take any prescription drugs, consider enrolling when you become eligible. You want to protect your health and finances and be covered if your situation changes.
How Medicare Prescription Drug Coverage Works
Medicare Part D helps you pay for your prescription drugs. Because Part D is a government program, the Centers for Medicare and Medicaid Services (CMS) closely oversee every aspect of the program. Every detail, from the drug list (also called the formulary) to how an insurance company sells its plans, is reviewed and approved by CMS.
Before an insurance company can sell Medicare Part D coverage, it must have its proposed benefits, premiums and the drug list approved by CMS. This makes sure the coverage follows federal guidelines and it protects you as a Medicare beneficiary.
Medicare Part D Eligibility
To be eligible for Medicare Part D, you must:
- Be entitled to Medicare benefits under Medicare Part A and/or enrolled in Medicare Part B
- Reside in the Part D plan’s service area
- Not be enrolled in more than one Medicare Part D plan at a time
If you are under 65 with a disability, you may also be eligible to enroll.
The four phases of Medicare Part D prescription drug plans
All Part D plans have these phases. Benefits offered by each carrier can vary.
- Annual Deductible: You pay this amount for your prescriptions before the private insurance company you choose begins to pay.
- Initial Coverage: You pay a copay or coinsurance for each eligible prescription filled.
- Coverage Gap: You pay your prescription drug costs until you reach a year-to-date True Out-Of-Pocket (TrOOP) cost (payments including deductibles, copays, coinsurance). During this time, you may be eligible for a discount on brand name drugs and a discount on generic drugs at the time of purchase.
- Catastrophic Coverage: You pay a copay for generics, a copay or coinsurance (whichever is greater) for other drugs, and coinsurance for specialty drugs after TrOOP costs are reached.
Depending on your income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you will only pay a small amount for your prescriptions and will have continuous coverage. If you have not already received an application for assistance, contact your State Medical Assistance office or the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov.
If you have additional questions, or if you’d like to learn more, you can call Medicare at 1-800 MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also visit www.medicare.gov for the latest news on this program.