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Information on Different Medical Plans for Medicare Part D

Medicare provides health insurance to those 65 and over and the disabled. Medicare Part D is Medicare's prescription drug benefit. It was signed into law in 2003 as part of the Medicare Modernization Act; coverage started Jan. 1, 2006. Medicare Part D isn't offered directly through Medicare, though. It's offered through private companies that are approved by Medicare. You can access Part D benefits in a number of ways, or you may not need it at all.

  1. Medicare Prescription Drug Plans

    • One option for Part D coverage is purchasing a Medicare Prescription Drug Plan, of PDP, from a medical insurance provider. These plans are designed for those who have original Medicare as their primary insurance, and either no secondary insurance, Medicaid (health insurance for low-income seniors and others) or a Medigap (Medicare Supplement) plan. Part D plans have a monthly premium and co-pays. Each plan has a formulary, or drug list, that classifies prescriptions into tiers. Each tier has its own co-pays. Formularies are company-specific, so if a drug is in tier two with one company, it may be in tier three with a different company. You can sign up for a plan when you first qualify for Medicare Parts A or B, and you can change plans once per year from Oct. 15 through Dec. 7.

    Medicare Advantage Plans

    • Medicare Advantage (MA) plans are also known as Part C of Medicare. MA plans take the place of Medicare Parts A and B, which cover hospitalization and other medical care, respectively. MA plans combine hospitalization and medical coverage into a plan with a relatively low monthly premium. This helps to offset the out-of-pocket costs associated with Medicare on its own (a hospitalization, for example, has a deductible of over $1,000). MA plans provide care through a network, which lowers costs for their members, keeping premiums and co-pays low. These plans usually include prescription coverage as well for no additional premium. Prescriptions still have co-pays, though.

    Other Prescription Coverage

    • There is a chance you don't need a Part D plan at all. If you're working or retired or have access to a spouse's employer-sponsored medical insurance with prescription coverage, you don't need to enroll into a Part D plan. If your coverage involuntarily ends, you'll have a special enrollment period of two full months. If you're a veteran, you may want to utilize your Veterans Administration or TRICARE prescription benefits.

    Medicaid

    • Medicaid is medical insurance for very-low-income seniors and the disabled. Medicaid is funded by the federal and state governments, so requirements and benefits vary a bit from state to state. In most, though, your Medicare Prescription Drug Plan premiums are completely covered if you qualify for Medicaid, and your co-pays are significantly lower. You can apply through your local Social Services office.

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