Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription coverage, “Part D”, to all individuals on Medicare. Beneficiaries can choose to enroll in:
- a Medicare prescription drug plan or
- a Medicare Advantage Plan that offers drug coverage and supplemental health insurance
Individuals can enroll in or change their plans during the open enrollment period from November 15th through December 31st each year. There are some exceptions to this open enrollment, called Special Enrollment Periods (SEP), for individuals who meet certain criteria. For more information on Special Enrollment Periods, or to have a comprehensive Medicare drug plan and medication review, call the Pharmacy Outreach Program at 1-866-633-1617.
All Medicare plans charge a monthly premium and, in some cases, an annual deductible. The average deductible in 2010 is $310. In the initial phase of coverage, drug plans also charge a co-payment for medications until the coverage gap, or “donut hole” has been reached. The coverage gap begins when the beneficiary and their drug plan have spent a total of $2830 towards medications. At this point, the beneficiary is responsible to pay the full price for medications. In 2010, the coverage gap ends when the beneficiary has spent a total of $4500 out of pocket for their medications. Once the total has reached $4500, the beneficiary enters the last phase of coverage, called catastrophic coverage. During this phase, the co-pay is reduced to 5% of the cost of the medication.
There are programs, such as Prescription Advantage (MA State Pharmacy Assistance Program – SPAP) and the Low Income Subsidy (LIS/Extra Help) through Social Security, to assist during this gap in coverage (for more information, see the Extra Help and Prescription Advantage sections). MCPHS Pharmacy Outreach Program staff will work with you to review your medications and Part D coverage and assess which programs and benefits you may be eligible for. We can also provide you with necessary applications. In addition, our staff pharmacists can provide an in depth medication review to identify other possible cost savings. For more information you can reach us at 1-866-633-1617.