Medicare Part D (Medicare Prescription
CMS contracts with private companies to offer Medicare
Prescription Drug Plans to people with Medicare.
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
People with Medicare can enroll in, or change, a
Medicare Prescription Drug Plan:
During the initial 7-month enrollment period
surrounding their 65th birthday.
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.
In certain situations, you may be able to join,
switch, or drop Medicare drug plans at other times.
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).