Medicare Part D - Prescription Drugs
Medicare Part D is the Prescription Drug benefit of Medicare. A prescription drug plan (PDP) is a stand-alone plan that works together with your Original Medicare. It is only offered through private insurance companies. This is a good option for someone who wants to stay in Original Medicare but add prescription drug coverage.
Another option to get Part D benefits is to enroll in a Medicare Advantage Plan that includes Part D. When you elect Part D coverage, you get an ID card to use at your local pharmacy that shows what your co-pay is for different drugs. Many plans also offer a mail order option for maintenance drugs as well.
You must have Medicare Part A and/or Part B to join a Medicare Prescription Drug Plan. For prescription drug coverage through a Medicare Advantage plan, you must have both Medicare Part A and Part B to enroll. You must continue to pay your Medicare Part B premium.
In addition, you must be age 65 or older, or under age 65 with qualifying disabilities, or have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis, also written as ESRD).
During the same seven-month window as Part B. That means during the three months before the month you turn 65, your birthday month and the three months after the month you turn 65.
You can join a Medicare prescription drug plan or switch to Medicare Advantage during the Annual Enrollment Period (October 15 - December 7).
You can also enroll during a Special Enrollment Period for special circumstances such as: losing your employee coverage, moving to a new service area or qualifying for extra help.
Each plan has a drug list (formulary) that shows which drugs it will cover. You should get a copy of the formulary from your plan. This information may also be available in the information packet sent to you by your plan. You should discuss your current medications with your doctor when you receive this information.
Both generic and brand drugs are covered under Part D. A generic drug has the same active ingredients and formula as its branded version but usually costs less. Most commercially available vaccinations, including the shingles vaccine, have also been covered by Part D since 2008.
Part D prescription drug plans do not cover drugs given in hospitals or doctors’ offices that are already covered under Part A or Part B, nonprescription drugs or prescription vitamins (other than prenatal vitamins) and any drugs not listed on a plan’s drug formulary (except in special circumstances).
If your drug is not covered, your physician may change your drug to a drug that is covered under your plan. If your physician wants you to stay on your drug, your drug plan must have a process for you to get drugs not on their formulary. You and your doctor can ask for an exception.
The late-enrollment penalty amount changes each year. The cost of the late-enrollment penalty depends on how long the person went without Part D or other prescription drug coverage. The penalty increase your monthly premium by 1% each month you delay your coverage.
In some cases, you could request reconsideration if you think Medicare did not count all of your creditable coverage or if you did not get a notice that clearly explained whether your previous prescription drug coverage was creditable.
