Medicare Part D FAQs

Medicare offers prescription drug coverage for beneficiaries through what is known as Medicare Part D. These drug plans are provided by private insurance companies that are Medicare approved. Depending on the area that a beneficiary resides in, there are numerous drug plans that he can choose from.

Coverage

• Medicare Part D is designed to provide coverage for both brand name and generic drugs. The drugs that are covered by each plan can vary. Plans are required to ensure that the beneficiaries under their plan can receive any drugs that are medically necessary to treat their illnesses. There are some drugs that plans are not required to provide coverage for. This includes drugs sold over the counter.

Costs

• Each plan under Medicare Part D will have various monthly premiums. The monthly premium is separate from the monthly premium for Part B. Beneficiaries may also be required to pay a yearly deductible and/or co-payments. There are some plans that may not charge for these. Depending on the plan chosen, this will determine how much a beneficiary pays for a prescription. All plans are required to provide the basic level of coverage that is predetermined by Medicare.

  A majority of the Part D plans will have a coverage gap. A coverage gap means that after a certain amount of money is spent for covered drugs by the beneficiary or their plan, the beneficiary will be required to pay all out-of-pocket costs for their drugs. Plans that do not have a coverage gap may have a more expensive monthly premium.

  If at any point a beneficiary reaches the out-of-pocket limit for her plan, she will begin to receive catastrophic coverage. With catastrophic coverage, a beneficiary will only have to pay a small co-payment for the remainder of the year. If a beneficiary receives extra help for her drug costs, she will not have a coverage gap and will only pay a small co-payment.

How to Pay

• There are four ways that beneficiaries can pay for the Medicare Part D. One way is by having the premiums deducted from their bank account. Premiums can also be charged to their credit or debit card. Some beneficiaries choose to be billed directly each month by their plan. Others choose to have their premiums deducted from their monthly Social Security payment. If a beneficiary qualifies for extra help, his plan premium may be covered.

When to Join

• Medicare beneficiaries are eligible to enroll in Part D under certain circumstances. One of these is when the beneficiary is first eligible for Medicare. This is normally three months before the beneficiary's 65th birthday. Another time period in which a beneficiary can join is during the three months before or after receiving their Social Security disability payment for the 25th month. There is also open enrollment between November 15 and December 31 of every year. If a beneficiary signs up during this time, January 1 of the next year is when her coverage will begin. Those who may qualify for extra help can enroll at any time. This includes beneficiaries who may receive Medicaid and/or Supplemental Security Income (SSI).

How to Join

• If a beneficiary is interested in enrolling in Medicare Part D, he will have to contact the private insurance company that provides the plan of interest. Beneficiaries can enroll by calling that particular plan or by faxing or mailing back a completed enrollment form. Some plans conveniently allow beneficiaries to enroll online. Beneficiaries can also join by calling Medicare or their Medicare plan.

  Once the beneficiary's enrollment has been approved, the drug plan will send him all of his membership materials via mail. This will include his membership card, handbook, provider information, a list of the drugs that will be covered, and other pertinent information.