Questions and Answers about Medicare Part D

What is Medicare Part D?

Medicare Part D is the prescription insurance coverage program of Medicare. Brand name and generic medications are covered at pharmacies who participate in the program.

Who is eligible?

Anyone who has Medicare, regardless of prescription costs, health status, income, or resources can get coverage. Seniors age 65 and older are eligible. Eligibility starts the third month before the month of the person’s 65th birthday.

How does it work?

It is similar to other insurances.

Members pay a monthly premium and have yearly deductibles.

The monthly premium is the cost you pay to join the drug plan.

The yearly deductible is the total you pay for your medications before the Part D plan begins sharing the costs.

Also, members will pay copayments or coinsurance on each prescription.

This is the cost of the medication that members are responsible for.

Coinsurance is a percentage of the prescription costs. Depending on which plan the member decides on, the costs will vary.

Those with limited resources and income may not have to pay a deductible or a premium for their Part D insurance.


What is the “donut hole”?

The “Donut Hole” is a gap in coverage in a members Part D plan.

This is what happens once the members costs accrue to an initial coverage limit.

At this point, the member is responsible for paying 100% of the cost for their prescriptions.

Some coverage in the donut hole is covered by certain plans.

Despite the existence of this coverage gap, members still pay less for their medications than they would without the Part D insurance coverage.



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