What is Medicare Part D?

What is Medicare prescription drug coverage?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare part D plans provide protection for people who have very high prescription drug costs or from unexpected prescription drug bills in the future.

Who can get Medicare Part D Coverage?

Everyone with Medicare is eligible for this Medicare Part D coverage, regardless of income and resources, health status, or current prescription expenses.

When can I get my Medicare Part D Plan?

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may pay a penalty. If you didn't join when you were first eligible, your next opportunity to join will be from November 15, 2009 to December 31, 2009.

How does Medicare Part D coverage work?

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible.

Why should I get Medicare prescription drug coverage?

Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.

CMS Part D 2010 Standard Benefit Model Plan Details

Here are the highlights for the CMS defined Standard Benefit Plans for 2006, 2007, 2008, 2009 and 2010. This "Standard Benefit Plan" is the minimum allowable plan to be offered. The details of the 2010 plan will not be released until mid-April 2009. As we learn details, they will be added to the highlights and chart below.

• Initial Deductible:
  from $295 in 2009 to $310* in 2010
• Initial Coverage Limit:
  from $2,700 in 2009 to $2,830* in 2010
• Out-of-Pocket Threshold:
  from $4,350 in 2009 to $4,550* in 2010
• Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
  from $2.40 for generics and $6.00 for other drugs in 2009 to $2.50 for generic or preferred drug that is a multi-source drug and $6.30* for all other drugs in 2010
• Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
  from $2.40 for generics and $6.00 for other drugs in 2009 to $2.50 for generic or preferred drug that is a multi-source drug and $6.30* for all other drugs in 2010.

Important Medicare Part D Dates for 2009-2010

• October 1, 2009:
  Medicare Part D Prescription Drug plan Marketing Activities can begin - At this time you will be able to once again gather information and evaluate the various Part D plan alternatives.
• Please note, no enrollments may be accepted before November 15, 2009.
• November 15 to December 31, 2009:
  Annual Coordinated Election Period - Here is your chance to join a Medicare Part D plan for 2010. If you already have a Medicare Part D plan, this is your time to look back over 2009 and make another decision for your 2010 coverage. Should you stay with your existing coverage or make a change? Here is your opportunity to decide. If you make no decision, you will remain in the same plan as you elected in 2009. There is no enrollment required to renew your present coverage. Don't forget the previous years! People who waited until the end of December also waited into January for the arrival of their Welcome Information. Bottom Line: Don't wait until the end of December to make your enrollment decision. (If you do not enroll during this period, your next chance for coverage is January 2011.)

• January 1, 2010:
  Your 2010 Medicare Part D plan becomes effective and you will be able to begin using your Part D benefits.

• January 1 to March 31, 2010:
  Open Enrollment Period (or OEP) - This special period is available for those people who enrolled into a Medicare Advantage Plan with Prescription Drug coverage (MA-PDs) and now wish to disenroll back to original Medicare coverage and a Prescription Drug Plan. As noted by CMS: "PDPs must accept enrollments for individuals enrolled in a MA-PD plan and who choose to elect Original Medicare during the MA OEP that occurs from January 1, 2010 through March 31, 2010. Since MA rules require these individuals to maintain prescription drug coverage, they MUST enroll in a PDP to accompany Original Medicare. This OEP allows MA-PD enrollees to enroll in a PDP and is limited to 1 enrollment."