What is Medicare Part D? - Medicare Consumer - Medicare Consumer

What is Medicare Part D?

Medicare Part D covers prescription medication. Part D plans are offered via private insurance carriers and not through Medicare directly. Therefore, the benefits that are provided, as well as the premium that is charged, can vary from one Plan D to another.

Each of the Medicare Part D plans has its own list of prescription drugs that it covers. This list is referred to as a formulary. Many of these prescription drug plans will place their covered medications into different “tiers” on their formularies, and in turn, the drugs that are in each of these tiers will have different costs.

As an example, a prescription medicine that is listed in a lower tier will generally cost less than one that is in a higher tier. There may be, however, certain instances where a prescriber feels that an individual needs a particular medication that is listed in a higher tier rather than another drug that is listed in a lower tier. In this case, the Medicare Part D plan participant may be able to obtain an exception for a lower co-payment amount.

In addition to just prescription medications, there are other types of drugs that may be covered by Medicare Part D. For instance, except for vaccines that are covered by Medicare Part B (Medical Insurance), Medicare drug plans are required to cover all commercially available vaccines, such as the shingles vaccine, when it is considered to be medically necessary in order to prevent illness.

In most instances, the prescription medicines that are received in a hospital outpatient setting such as an emergency department or during observation services – oftentimes referred to as “self-administered” drugs – are not covered by Medicare Part B. Therefore, in some circumstances, these may be covered under Medicare Part D. In this case, however, the Part D beneficiary may be required to pay initially out-of-pocket for the drugs, and then submit a claim to the Part D plan for reimbursement.


How Much Does a Medicare Part D Plan Cost

The expense that is related to Medicare Part D will vary based on a number of different criteria. These include the medications that are required by the Part D enrollee, as well as whether or not the medications are listed in the Part D plan formulary. In addition, the cost will also be dependent on whether the Medicare Part D enrollee obtains his or her medications from a pharmacy that is listed in their plan’s network.

Also, there may or may not be a deductible that is required to be met before a Part D plan will begin to pay out its benefits. While the amount of a Medicare Part D plan’s deductible may vary, in 2015, the amount is not allowed to exceed $320.


How Can You Obtain a Medicare Part D Plan

There are two ways in which Medicare Part D prescription drug coverage may be obtained. One is to purchase a stand-alone Part D plan that will add this coverage to Original Medicare (Part A and Part B) benefits.

An alternative way of obtaining Medicare prescription drug benefits is to purchase a Medicare Advantage plan – also known as Medicare Part C – that already provides prescription drug coverage within the overall plan.

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