Components of Medicare Part D

The elderly and disabled population rely on their prescription drugs. Getting their drugs at an affordable price is vital, otherwise many resort to skipping doses or splitting pills. That is why Medicare, the federal health insurance program for the elderly and disabled, introduced Part D for prescription drugs. There are many different aspects of Part D that are key to understanding the program.

Required Drugs

• Medicare Part D coverage will be different from plan to plan, however, there are some classes of drugs that a Part D plan are required to cover according to regulations. These include drugs in the immunosuppressant, antidepressant, antiretroviral, antipsychotic, anticonvulsant and antineoplastic classes. The Centers for Medicare and Medicaid requires that Part D plans cover the majority of medications in these classes according to the CMS Part D Manual.

Excluded Drugs

• According to federal regulations, some classes of drugs are excluded from coverage, meaning that no Part D plan can use Medicare funds to cover these drugs. Many Part D plans still cover them, but at a higher price because they are not subsidized by Medicare. These drugs include benzodiazapines, barbiturates, vitamins and minerals, drugs used for weight loss or gain, over-the-counter drugs and drugs taken for cold and cough.

Options

• Medicare Part D is offered exclusively through private insurance companies. If an individual has traditional Medicare, they must purchase a stand-alone Part D plan. Others can purchase Medicare Advantage packages which are typically bundled with a Part D plan. Plan selection varies from region to region.

Costs

• Because Part D is offered by private insurance companies, the costs are different from plan to plan in order to appear competitive. A typical Part D plan will charge a monthly premium, a deductible and a co-payment for each drug. The co-payment is usually based on whether the drug is generic, brand name or a preferred brand name drug. Those who have trouble paying the costs of Part D can apply for Extra Help, a federal low-income subsidy that helps with the costs of the benefit.

Protections

• Part D enrollees are entitled to some basic rights and protections under federal regulations. A Part D beneficiary can switch Part D plans during the designated enrollment period called the annual coordinated election period, which lasts from November 15 to December 31 each year. They may switch for any reason. Also, Part D enrollees may qualify for a special enrollment period allowing them to switch outside of the designated enrollment period if they were wronged by the Part D plan through illicit means, such as marketing fraud. Finally, a Part D beneficiary has the right to a process of appeals if he deems any service denial unjust.