Medicare Part D
Medicare beneficiaries who wish to add prescription drug benefits to their Original Medicare (Part A and Part B) coverage can choose to enroll in a Medicare Part D Prescription Drug Plan. These stand-alone plans are available from private Medicare-approved insurance companies. Stand-alone Medicare Part D Prescription Drug Plans are available to beneficiaries who are currently enrolled in Medicare Part A or Part B.
There's another way to get your Medicare Part D coverage: you can enroll in a Medicare Advantage Plan, and get all your Medicare benefits through a single plan. Medicare Advantage (Medicare Part C) plans are offered by private insurance companies with Medicare's approval, and each plan must include at least as much coverage as Medicare Part A and Part B (except for hospice care, which is still covered by Part A). No matter what kind of Medicare Advantage plan you enroll in, you must continue paying your Medicare Part B premium, as well as any premium your Part C plan may charge.
Beneficiaries with a Medicare Advantage plan that does not include prescription drug coverage may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan. However, you may want to check with the Medicare Advantage plan to make sure it doesn't include this coverage. If you enroll in a stand-alone Part D Prescription Drug Plan while enrolled in a Medicare Advantage Prescription Drug plan, you could be dropped from the Medicare Advantage plan and returned to Original Medicare.
What is Medicare Part D (Prescription Drug Coverage)?
Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You may need to enroll when you first become eligible to keep from paying a late enrollment penalty later. Part D was designed to help people with Medicare by lowering their prescription drug costs and to protect against future costs. A prescription drug plan may also enable you to have greater access to medically necessary drugs.
How Can You Get Part D Coverage?
There are two ways to join the Medicare prescription drug coverage plan. The first is by adding it to your Original Medicare Plan or some Medicare cost plans, private fee-for-service plans, and Medical savings account plans. The second way is to join an HMO or PPO plan that includes Part D coverage. You may have to pay a monthly premium that will vary according to the plan you choose.
Adding Medicare Part D to the Original Medicare Plan
If you are in the Original Medicare Plan, you may add Part D coverage. Generally, you will pay a separate premium and in some cases a deductible.
Adding Medicare Part D to the Medicare Advantage Plan
If you are in the Medicare Advantage Plan, then chances are you already have Part D coverage. However, some plans offer Medicare Advantage without drug coverage. In most cases, you cannot mix and match a Medicare Advantage plan with a separate Part D drug plan.
How Part D Works
After you join, you will receive a membership card and materials via the mail. Under most plans, you will pay a copay or coinsurance. Some plans will also have a yearly deductible to meet before benefits begin.
Most Part D plans have a coverage gap (also referred to as a donut hole). This usually means that the amount you pay and what the plan pays will change after certain amounts have been reached. This benchmark amount is set by Medicare each year and is a total of what you pay and what the plan pays. Generally, copay amounts are replaced by discounted amounts for generic and name brand drugs.
Catastrophic coverage begins once you have met certain out of pocket amounts, also established by Medicare annually. Once qualified, you only pay a small copay or coinsurance for covered drugs the rest of the calendar year.