November 22, 2011
Medicare Part D
What is Medicare Prescription Drug Coverage?
Medicare Part D is the government's prescription drug benefit for Medicare enrollees created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare enrollees may access Medicare Part D benefits by signing up for a Medicare-approved Part D drug plan offered by a private insurance company. An enrollee may also access these same Part D drug coverage benefits by signing up for a Medicare Advantage plan that includes prescription drug coverage alongside its medical services. In either scenario, the enrollee is required to pay the monthly premium charged by the plan and these premiums vary by insurance provider.
Each Medicare Part D drug plan has its own list of covered prescription drugs called a "formulary." Medicare requires all Part D prescription drug plan options to cover at least two medications within each therapeutic category. A therapeutic category is a classification of drugs sharing the same purpose (e.g. antidepressant, antibiotic). Part D plans may include more than two drugs from each therapeutic category. Medicare specifically excludes from Part D plans drug coverage for medications treating fertility, hair growth, anorexia, and some other conditions. Over-the-counter items such as aspirin and vitamins are also not covered by Part D plans.
The number and variety of Medicare Part D drug plans leave consumers with no easy answer to the question "What is the best Medicare Part D drug plan?" Consumers must compare Part D drug plans and, with this drug plan comparison, determine which plan is most affordable and advantageous given their individual drug usage, pharmacy availability and other factors that may be important to them. PlanPrescriber.com allows you to compare Medicare Part D plans using our plan comparison tool. The tool personalizes annual cost estimates for plans based on the drugs you indicate you use monthly so that you can replace the generic question "What Part D plan should I choose?" with the more specific "What is the right Part D plan for me?"
Whether you take popular drugs such as Lipitor, Zocor, Glucophage, or Norvasc, you should do your homework before enrolling in a Medicare Part D plan. Since each Part D plan can cover different drugs, it is essential to evaluate all Part D plans in your area to determine:
- If your drugs are covered
- What are the estimated out-of-pocket expenses you should expect to pay during the year for your drugs and plan premiums
- If there are any limitations placed on your drugs (e.g. monthly quantity limits, prior authorization)
PlanPrescriber provides a free Medicare Part D plan comparison tool that can answer the above questions for your personalized medication usage.
What is Medicare Part D?
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Medicare Part D Eligibility
Anyone enrolled in either Medicare Part A or Medicare Part B is eligible to enroll in a Medicare Part D plan. Medicare Advantage plans with prescription drug coverage require you to also be enrolled in Medicare Part B as well as Part A before you are eligible to enroll. Part D plans do not review your medical history to determine if you can enroll in a plan. However, since the Part D coverage is voluntary, you have the responsibility to select a Part D plan and enroll.
You may only join a Medicare Part D plan during an enrollment period for which you qualify.
Medicare Part D Enrollment
Enrolling in Medicare Part D is simple. A relatively short application for the Part D plan must be completed. This Part D application asks for your name, address, Medicare beneficiary number, and other information. PlanPrescriber can assist you by phone (888-312-5447) or through our tool to compare Medicare plans. This tool has links to online forms for some Part D plans and contact forms for other Part D and Part C plans so that a licensed agent can call you and assist you with the enrollment process.
Medicare Part D Premiums for 2012
Premiums for Medicare Part D insurance not only vary by Part D plan but may also vary by region. Moreover, each year a Part D plan may change its premium based on estimated cost increases. Given this situation, the most affordable Part D plan for you last year may not be the right Part D plan for you this year. By reviewing your Part D plan options annually, you are in the best position to maximize your savings and available benefits.
The government has a program to assist low-income individuals in Part D plans with their Part D deductible, premium, and co-payment expenses. The program is known as "Extra Help" or the "Low Income Subsidy" (LIS). For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
Deductibles and Other Costs
A standard Medicare-contracted Part D drug plan has a deductible period where you are responsible to pay 100% of the drug costs until the deductible amount is satisfied. In 2012, the Part D deductible amount may not be higher than $320. After you spend an amount equal to the deductible, you will pay a co-payment (or a co-insurance fee representing a percentage of the drug's full price) for a covered drug. Some Part D drug plans waive the deductible or reduce it to a lower amount.
The most affordable Medicare Part D plan for you may not necessarily be the Part D plan with the lowest monthly premium. A Part D plan may also involve deductibles, out-of-pocket expenses for drugs, and the 'Part D donut hole.' PlanPrescriber highly recommends that you use our Part D plan comparison tool or similar tool to objectively compare your annual Part D drug coverage costs (i.e. premiums, deductibles, and out-of-pocket expenses) among Part D plans for the drugs you are currently taking. By evaluating all your medication-related spending, you can make a more informed choice on what Part D plan may be right for you.
