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MEDICARE PART D Rx (Prescription Drug Coverage)
Medicare Part D was created under the Medicare Modernization Act of 2003. It was implemented by the Centers of Medicare and Medicaid Services. Medicare Part D, prescription drug coverage, is the latest benefit to compliment Original Medicare. Prescription Drug coverage is an optional benefit offered to everyone who has Medicare. To qualify for the benefit, a beneficiary must be eligible for Medicare Part A and enrolled in Medicare Part B coverage. Certain MA only plans do not include prescription drug benefits, and a stand alone Part D plan option is not available for that situation.
If a beneficiary chooses not to utilize Medicare drug coverage, upon becoming initially eligible, there will likely be a late enrollment penalty, unless the beneficiary has a credible prescription drug coverage. Prescription drug coverage, from an employer or union, that is expected to pay at least as much as Medicare's standard prescription drug coverage, eliminates the penalty. Plus, you may receive "Extra HELP," a program offered through state Medicaid, available to any beneficiary who qualifies for financial assistance. With "Extra Help," there is no late enrollment penalty. If the beneficiary joins a Part D drug prescription plan beyond the 63rd day, there is a 1% per month penalty; calculated by and paid to Medicare. When the beneficiary has existing credible prescription coverage, there is no penalty for electing Part D coverage at a later date.
Understanding Drug Coverage
A Medicare prescription drug plan: Part D, adds drug coverage to Original Medicare, Cost Plans, some Medicare Private Fee for Service Plans and Medicare Medical Saving Account Plans. A Medicare Advantage Plan, Part C, such as a HMO or PPO, usually offers Medicare prescription drug coverage within the plan. Medicare Advantage Plans, offer coverage similar to Original Medicare Part A, for hospital insurance, Part B, for medical services coverage. Medicare Part D - prescription drug coverage is included with most Advantage plans. An Advantage Plan is sold through private insurance providers; and is not a part of Original Medicare. You must, however, be enrolled in Medicare Part A and Part B to qualify for a Medicare Advantage Plan. Prescription Drug plans, Part D, can be purchased as a stand-alone benefit. A Part D plan is provided through a private insurance company. In addition, Part D plans offer variable benefits and formularies determined by the insurance provider and regulated by the CMS.
Before joining a Medicare prescription drug plan, speak with a licensed and certified advisor to determine if any other existing benefits are available. You may have coverage through an employer, union, TRICARE, the Department of Veteran's Affairs (The VA), or Indian Health Services. Offering a Medicare Advantage or Part D Benefit in connection with these other coverages may permanently terminate or void the prior coverage.
Prescription Drug Plans offer:
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Annual deductible for various tiers of drugs
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Coverage for at least 2 drugs in each drug class
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Coverage for antidepressants, antipsychotics, anticonvulsants, retroviral (AIDS treatments), anticancer medications and immunosuppressants
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Option to include medically necessary drugs to the plan
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A network of pharmacies for convenient access
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Coverage for Nursing homes
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Assistance with a transition to current drug coverage
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Catastrophic coverage
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Drugs NOT Covered by Part D:
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Over The Counter drugs
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Prescription vitamins and minerals
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Fertility drugs
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Erectile dysfunction drugs
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Drugs for weight gain or loss
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Drugs to treat the common cold
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Medications covered under Medicare Part A or Part B