Medicare Part-D, or prescription drug benefit, is the component of the Medicare that offers outpatient drug coverage. Unlike Original Medicare, this plan is not directly offered by the government. Only private insurance companies with contracts with the US federal government provide this plan. Most Medicare Advantage Plans offer Medicare Part D (prescription drugs coverage). However, you will be required to enroll in a Medicare drug plan for some of the plans that do not offer prescription drug coverage (such as Medigap, Private Fee-for-Service Plans and Medical Savings Account Plans). To get the benefits of Part D coverage, you will have to enroll in the Medicare Advantage Plan with drug coverage (MAPD) or private Medicare prescription drug plan (PDP).

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All You Need to Know About Medicare Part-D

There are various medical health plans, such as Medicare Part A (hospital insurance) and Medicare Part B (Medical Insurance); however, in this article, you’ll get to know all there is to know about Medicare Part D (Prescription Drug Plan).

Previously, Medicare used to pay for specific drugs administered to patients at doctor’s offices or during hospital admission. This cost was covered by Medicare Part A. It was until 2006 that Medicare did not cover prescription drugs for outpatients.

After 2006, Medicare Part D (prescription drug benefit) was implemented under the Modernization Act of 2003, authorized by Congress. Previously this act was called the MMA. This Part D drug benefit act was approved to help elderly medical recipients pay for outpatient prescription drugs procured at mail order, retail, home infusion, or long-term care pharmacies.

Benefits of Medicare Part D

PDPs only offer Drug coverage and work together with your Original Medicare or Medigap plan. This is a good option for someone who wants to stay in Original Medicare but add prescription drug coverage.

• Cost Protection PDP helps elderly people against expensive prescription drugs by providing them with different cost coverages depending on various tiers of drugs.
• Affordability Prescription drug plans with low monthly premiums make the drug plans affordable for elders who struggle financially in their old age.
• Flexibility Medicare Part D provides multiple options in terms of benefits and cost levels based on the needs and other medical coverages.

Medicare Part D Coverage

Compare Part-D Drug Prices

Any Medicare Plan with a Part D stand-alone prescription drug plan (also known as “Medicare Rx”) or a Medicare Advantage Plan with prescription drug coverage (MAPD) you choose involves a list of covered prescription drugs, known as a “Formulary.” The formulary must contain at least 2 drugs that fall under the commonly prescribed classes and categories. It ensures that individuals with varying medical conditions get the required prescription drugs. Part-D contains all drugs available in the categories listed below:

• Antipsychotic medications
• Antidepressants
• AIDS/ HIV treatments
• Immunosuppressant drugs
• Anticonvulsive treatments for seizure disorders
• Anticancer drugs (that are excluded by Part B)
• Vaccines (most are already covered by Part B)

Prescription drugs that Medicare Part Do Not Cover

Excluded drugs are not coverable under Part-D, but may be offered as a supplemental benefit in some enhanced plans. Most Part D prescription drug plans do not cover the following:

• OTC (Over the Counter) drugs
• Supplements/vitamins
• Weight loss/cosmetic medications
• Fertility medications
• Drugs used to cure anorexia or weight gain/weight loss medications
• Cosmetic drugs (hair growth or other cosmetic purposes)
• Medications for erectile dysfunction
• Drugs that are covered under Medicare Part A or Part B

If the formulary does not include any prescribed drug, you can either file an appeal, request an exception, or pay out of your pocket. You may not appeal the denial of excluded drugs and their cost will not count toward your MOOP.

Medicare Part D Eligibility

Currently, around 24 million individuals are already enrolled in the PDP. In order for you to be eligible for the Part D plan coverage, make sure you are already enrolled in the Original Medicare (Part A and Part B).

If you are eligible for Medicare Plan D, apply for the plan during the set enrollment period. In case you are unable to provide creditable coverage or cannot sign up after being eligible for the Part D plan, you will need to pay the late enrollment penalty monthly once you get enrolled.

Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period.

• Initial Enrollment Period (IEP) This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you should sign up for the PDP.
• Annual Enrollment Period (AEP) Also known as the Medicare Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your Part D plans.
• Special Enrollment Period (SEP) This enrollment period depends on the personal circumstances of the beneficiaries. Here, you first need to determine your situation to decide whether you should enroll, leave, or modify the prescription drug plan.

In Conclusion

Choosing the right Medicare plan is vital, be it an Original Medicare plan or Medicare Advantage Plan. When it comes to choosing the Medicare Part D (Prescription Drug Plan), make sure you thoroughly evaluate the various drug coverage options, copayments, coinsurance, deductibles, and premiums of the drug plans. More importantly, don’t forget to consider the medications you want to cover from your Medicare drug plans.

Last updated on November 11, 2022