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Health Care Fraud

Medicare Part D (Medicare Prescription Drug Coverage)

CMS contracts with private companies to offer Medicare Prescription Drug Plans to people with Medicare.

Eligibility

Anyone with Medicare Part A, B or both, is eligible to join a Medicare drug plan and must enroll in a plan to get Medicare prescription drug coverage.  Eligibility is not based on income.

Enrollment

People with Medicare can enroll in, or change, a Medicare Prescription Drug Plan:

  1. During the initial 7-month enrollment period surrounding their 65th birthday.
  2. During the annual enrollment period – November 15th through December 31st each year. Costs may increase if the Medicare beneficiary did not enroll in a plan when first eligible.
  3. In certain situations, you may be able to join, switch, or drop Medicare drug plans at other times.

Costs

  • Premium – the monthly amount a beneficiary pays for this coverage varies according to the plan chosen and the coverage offered under the plan.
  • Deductible – the amount a beneficiary must pay before the plan begins coverage. This amount may increase each year. Not all plans require that a deductible be met before coverage will begin.
  • Co-payments – plans generally require the beneficiary to share in the monthly cost of medications. These amounts vary from plan to plan.
  • Coverage gap (“donut hole”) – A beneficiary is responsible for 100% of the cost of their medications once drug costs reach the current limit, and must incur a stated amount of out-of-pocket expense for the plan’s payment to resume, excluding the amount paid in premiums. Some plans offer coverage in this gap for generics and/or brand name drugs. The amounts may change each year.

Beneficiaries are encouraged to compare plans prior to enrolling as coverage varies.  Drugs covered, co-payment amounts, deductibles, and gap coverage are different for each plan.  A plan comparison tool is available on the Medicare website (www.Medicare.gov).

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