Medicare Part D

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Medicare is a program offered by the U.S. Federal Government that provides health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig's disease.[1] The Medicare program consists of four parts: Part A - Hospital Insurance, Part B - Medical Insurance, Part C - Medicare Advantage Plans, and Part D - Prescription Drug Coverage.[1]

Medicare Part D is an optional plan that helps Medicare recipients with their prescription drug costs. In order to receive Medicare prescription drug coverage, patients must be enrolled in a Medicare drug plan with an insurance company or other private company approved by Medicare. Depending on where a patient lives, there might be multiple Medicare drug plans from which to choose. To find a plan in a specific area, patients can call 800-MEDICARE or go to the Find-A-Plan page on the Medicare website.[2]



Flickr: CarbonNYC
Available through U.S. Federal Government, Medicare program
Phone 800-MEDICARE
Address Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244-1850
Eligibility People 65 or older, under 65 with certain disabilities, or with End-Stage Renal Disease or Lou Gehrig's disease
Benefits Prescription drug coverage
Disclaimer The information provided by PharmacyDrugGuide is not a substitute for professional medical advice, diagnosis, or treatment. Do not take any action based on the information on this page without consulting a physician.
Author Susan MacDowell


Medicare Part D Overview

Medicare Part D is one option to help consumers cover the cost of prescription drugs, and may help lower prescription drug costs and protect against increased costs in the future. There are specific requirements as to when consumers are eligible to join a Medicare drug plan. In addition to the annual open enrollment period, which runs from October 15 through December 7, consumers also have the option to enroll in a Medicare drug plan upon becoming eligible for Medicare due to age or disability. Consumers who qualify for Extra Help are able to enroll at any time.

It is important to note that Medicare Part D has a late enrollment penalty that may be added to a patient's Part D monthly premium. This penalty is accessible if consumers choose not to enroll when they first became eligible and do not have other creditable prescription drug coverage for more than 63 days in a row, at any time, after their eligibility ends.

It is important to choose a Medicare drug plan carefully as they can differ in the drugs they cover and the rules for obtaining coverage. Medicare drug plans must cover all commercially-available vaccines (with the exception of flu shots and other vaccines covered under Part B).[3] Medicare drug plans also cover certain brand-name and generic prescription drugs. Each drug plan has its own list of approved drugs the plan will cover. These formularies are further broken down into "tiers," depending on their cost.[3] Some drug plans require prior authorization before filling certain prescriptions, and may limit the amount dispensed at one time. In some cases, plans institute "step therapy," which means they may require patients to try one or more lower costing drugs before covering the prescribed, higher cost medication. [3]


Medicare Plan Finder

The Medicare Plan Finder compares available plans by area. Information compared includes estimated annual drug costs, monthly premiums, deductibles and co-pays, drug coverage and restrictions, and an overall plan rating. Consumers are able to perform either a "generalized" search by entering a zip code or a "personalized" search by entering a zip code, Medicare number, a last name, an effective date of the patient's Medicare plan, and a date of birth.[4]

Medicare Part D Donut Hole

The Medicare Part D coverage gap, or "donut hole," is a temporary limit that is set on what the drug plan will cover. This coverage gap may occur if consumers spend over a certain amount for covered drugs. Once in the coverage gap, consumers will receive a 52.5 percent discount on covered brand-name drugs and a 14 percent discount on generic drugs. In 2013, the discount on brand-name drugs remains 52.5 percent, but the generic drug discount will increase to 21 percent. To enable consumers in the gap to get out faster and resume normal coverage, the entire cost of brand-name drugs will count toward the out-of-pocket expense.[5]

AARP Medicare Part D Plan Member Stories

Testimonials from AARP Medicare RX prescription drug plan participants.

Also See: Patient Assistance Programs, Drug Coupons, Drug Side Effects, FDA, Walgreens Prescription Club, AAA Prescription Savings Program, CVS ExtraCare Program, Rite Aid Wellness Program, AARP MedicareRx Plan



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