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Medicare Part D

Medicare Part D was created because the original Medicare did not offer drug coverage for its participants; the original plan was limited to hospital care. Senior Americans’ increased demand for prescription medication led to the Medicare Prescription Drug, Improvement and Modernization Act (2003), which created new coverage for prescription drugs under Parts C and D.

Although Medicare oversees the various plans and the coverage they offer, the plans themselves are sold by private insurance companies. As such, pricing may be variable. The federal government reimburses private health insurance companies that offer these prescription drug plans.

If you are enrolled in Medicare, there are two primary plan options for drug benefits. Part D offers a prescription drug plan that covers just about everything (excluding barbiturates, benzodiazapines and cough suppressants). However, coverage varies by area, so it is best to check what is available near you. If Part D does not suit your circumstances, you may opt to join Part C (Medicare Advantage).

Part D costs its subscribers an annual deductible, a monthly premium, and co-pays for prescriptions. If your household is designated as low-income, the premiums and deductibles may be waived. Medicare Part D automatically lowers the cost of drugs for qualifying seniors.

Medicare Part D has one major drawback, a gap called the “donut hole.” This gap affects individuals whose coverage costs are over $2,501 but whose coverage does not reach the upper Catastrophic Coverage level. Additionally, the qualification numbers change each year due to recalculation, so a beneficiary who qualified for Catastrophic Coverage one year may not the next (unless their cost for drugs once again goes over the newly calculated threshold). As you consider Part D, remain aware of where you would stand within the coverage system.

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