Coverage: Part D helps pay for outpatient prescription drugs. You have to choose a prescription drug plan in your area to receive Part D benefits. In most cases, you will be required to use only the plan’s network pharmacies in order to receive full plan benefits and you may be limited to a formulary, which is a list of specific drugs covered by the plan you choose. Not all drugs are covered by all plans.

The pharmacies in the plan’s network and the drugs included in their formulary can change periodically. If the formulary or pharmacy network changes, you will receive a notice from your Part D plan administrator.

Administration: Private companies administer Part D. These companies, called Carriers, receive funding from the Federal Government to administer the plans.

Enrollment: Enrollment in Part D is optional and voluntary. No one is required to participate in Part D. You can enroll in Part D anytime during your Initial Enrollment Period. Your Part D Initial Enrollment Period coincides with your Part B Initial Enrollment Period. It begins three (3) months before the month you turn age 65 and ends three (3) months after the month you turn age 65.

NOTE: If you miss your Initial Enrollment Period, there are two (2) subsequent Enrollment Periods for you to enroll in Part D:

• Special Enrollment Period – If you wait to enroll in Part D because you already have creditable drug coverage through another source (like an employer or union group health plan, FEHB or COBRA), you can sign up for Part D anytime you choose or if the other coverage is discontinued. The Special Enrollment Period lasts for three (3) months after the other coverage ends.
• Annual Enrollment Period – If you don’t enroll during your Initial Enrollment Period and you do not have another source of creditable drug coverage, there is an Annual Enrollment Period that runs from November 15th through December 31st of each year. Your Part D coverage will start on January 1st of the following year. There may be a penalty of 1% per month on your Part D premium for every month you could have had Part D coverage but didn’t take it.

Cost: There is a premium for Part D prescription drug coverage, which most beneficiaries must pay. This premium can change annually.

NOTE: Medicare beneficiaries in the greatest need — those who have limited assets and incomes below a certain level — may be eligible for assistance with their Part D premiums, deductibles and co-pays. Requirements for low income assistance vary by state and can change annually (click here for low income requirements).

Depending on the benefit design of the plan you choose, there can be annual deductibles, coverage gaps, co-payments and/or coinsurance amounts. You are NOT allowed to purchase insurance to supplement Part D prescription drug plans — you must pay all deductibles, coverage gaps, co-payments and/or coinsurance amounts out of your own pocket. These expenses can change annually.



Sources Referenced

• www.medicare.gov
• Medicare’s Medicare & You
• Centers for Medicare & Medicaid Services
• Senator Bob Dole’s Ten Things You Need To Know About Medicare’s New Prescription Drug Coverage
• Walgreens’ Introduction to Part D: Medicare’s New Prescription Drug Coverage
• Kaiser Family Foundation’s Talking About Medicare: Your Guide to Understanding the Program