Medicare Part D: The Prescription Drug Benefit

The Medicare Prescription Drug Benefit (Part D) is unlike many employer sponsored drug plans that provide first dollar coverage and a uniform co-payment for every drug purchase, the Medicare plan is more of a catastrophic insurance plan which includes the following features for 2010:

  • Participation in this plan is voluntary.

  • Medicare beneficiaries have the option to sign up for a stand-alone drug plan or join a private health plan that offers drug coverage.

  • Although the monthly premiums can vary depending of the plans and coverage, the basic monthly premium is about $39 for a stand alone plan.

  • The basic annual deductible is $310 for a stand alone plan.

  • Medicare would then cover 75 percent of drug costs from $310 to $2,830 for a basic stand alone plan. There is no additional Medicare coverage for drug costs until a beneficiary spends $4,550 out of their own pocket. This gap has been referred to as the ?donut hole.?

  • Once a beneficiary spends $4,550 out of their own pocket on prescription drug costs, Medicare covers 95% of the rest of their prescription drug costs for that year.

  • Keep in mind that extra help to pay for Medicare Part D is available for beneficiaries with low incomes and limited assets.

Benefit Plans Negotiate Discounts

Keep in mind that many large benefit plans negotiate significant volume discounts. Through the new Medicare prescription drug benefit they will pay the lower prices negotiated by plans. However, Medicare beneficiaries who fail to sign up during their initial enrollment period will be subject to a late enrollment penalty if they choose to sign up later, unless they can show that they had other creditable prescription drug coverage through a retiree plan, veterans? benefits, etc. The idea is to discourage healthy people who currently have no other drug coverage from waiting ?until they need it? to enroll.

Conduct Careful Research

It is important for Medicare beneficiaries to conduct careful research before they decide whether or not to enroll in Medicare Part D (the Prescription Drug Benefit), because unfortunately, if a mistake is made during the open enrollment period, it could prove very costly at a later date. To learn more contact Medicare at 1-800-MEDICARE (1-800-633-4227) or www.medicare.gov.

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