Components of Medicare Part D
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Required Drugs
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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
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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
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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
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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
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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.
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