Elder Care Guide and Information

The Medicare Part D program provides people who are covered by Medicare Part A and Part B help paying for prescription drugs. Medicare Part D was added to as a pharmaceutical assistance program to the other Medicare programs in January 2006. Benefits are not provided within the regular Medicare program. Beneficiaries are required to enroll in one a Medicare Part D plan offered by private companies in their area.

People can sign up for Medicare Part D and pharmaceutical assistance program at only one time during the year: between November 15 and December 31. During this those who have Medicare coverage may enroll in a plan. They can also change from one plan to another. If you are already in a Medicare Part D plan this would be the time to decide if it’s the right for you for the coming year.

Medicare Part D is optional. Deciding not to enroll in it will not jeopardize your enrollment in Part A and Part B. If you choose to not sign up when first eligible will pay an increased premium of about 1% of the monthly premium when you decide to enroll later.

Medicare Part D drug coverage is not provided by the government directly. Instead this pharmaceutical assistance program is a number variety of private insurance plans. You have two enrollment options: choose a separate Prescription Drug Plan (PDP) and remain in the traditional Part A and B Medicare Program or select a Medicare Advantage plan which offers a prescription drug benefit (MA-PDP).

For 2007, the standard benefit requires an initial $265 deductible. Then, the beneficiary pays 25% of the cost of drugs covered under Part D up to $2,400. When that level is reached, you are then subject to additional deductible. The second deductible is sometimes called the “Donut Hole,” or “Coverage Gap”.

You pay 100% of drug costs until your total out-of-pocket expenses on covered drugs is $3,850. This includes all deductibles and co-insurance. This is called the “Catastrophic Coverage“ point. If you receive Catastrophic Coverage you pay the greater of $2.15 for a generic or preferred drug and $5.35 for other drugs or a flat 5% coinsurance.

When looking into Medicare part D and pharmaceutical assistance programs, you might want to consider lowering your costs during the “Donut Hole”.

Filed under: Elder Care, Medicare RX, Prescription Drugs