What is Medicare Part D?

Medicare was an addition to medicare’s health coverages starting in 2006. Unlike the other plans under medicare, coverage must be obtained through a private company that serves as the administrator of the plan.

Medicare Part D Qualification

Medicare Part D provides partial coverage for the cost of prescription medications for qualified persons. To qualify, a person must be on original medicare part A and/or part B. If they are, then they may enroll in any medicare drug program offered.

For seniors receiving their coverage through a medicare advantage plan, enrollment in medicare part A and part B is required. Enrollment in the drug plan and administration of it, will be handled by that same medicare advantage plan provider.

Medicare Part D Coverages

Medicare Part D will cover 75% of the prescription drug cost once a deductible has been paid by the patient. Most prescription drug plans (PDPs) supplement this coverage with a waiver of the deductible or a reduction in the amount of the deductible.

In addition, PDPs may further reduce the out of pocket cost of the drugs, from the 25% set by medicare, to as little as zero. This is not free and the PDP will charge a monthly premium for the plan. The amount of coverage will depend on the premium and each senior needs to find the plan that fits them best.

Part of the consideration in choosing a PDP, should be how it addresses the ‘doughnut hole’, where the coverage from medicare stops. This becomes very important for any senior experiencing prescription drug costs exceeding approximately $250 per month. Once the other side of the doughnut hole is reached, medicare coverage resumes. Getting caught in the middle can cost you a lot of money.

There are a lot of PDPs to choose from, so talk to more than one before making a decision.

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