Plans Within Medicare Part D

Medicare Part D was introduced in 2006 to provide millions of senior citizens access to prescription drug coverage. Medicare Part D plans provide a voluntary supplement to an existing coverage, making generic and prescription drugs more affordable for seniors by providing a more comprehensive range of coverage.

With Medicare Part D coverage varying from state to state, nearly 2000 possible Medicare Part D plans is offered to senior citizens. Beneficiaries have the option of choosing between a range of plans provided by private insurers, either as stand-alone prescription drug coverage or in combination with a Medicare Advantage plan.

Medicare Part D Plans are designed to provide the maximum benefit to individuals taking large amounts of medication on a regular basis. Plans are designed around a deductible, which must be met before any benefits are paid out. Once the deductible is reached, beneficiaries pay a full quarter of their prescription costs up to a benefit ceiling of $2830. At this point, seniors without a supplemental gap insurance become at risk of falling into the fabled “donut hole,” in which no additional medication is covered by the policy until expenses reach a catastrophic level of $4550 in out-of-pocket costs. Medicare Part D Plans are then required to cover all future costs, with the exception of minimal co-pay.

Participants in Medicare Part D Plans are encouraged to choose generic medications when possible, as these are covered by a wider range of plans and are generally available with lower co-pays. Although the Medicare program cannot negotiate lower prices for the program, the competition inherent to generic medicines, as opposed to the list of drugs the plan covers consistently yields lower prices. As not all medications can be obtained as generics, , Medicare provides a Prescription Drug Plan Finder tool online that analyzes those medications and identifies the best plan for each individual beneficiary to ensure the lowest cost.

Given that many seniors are often forced to live on a fixed income, premium and co-pay subsidies are available for low-income program participants to provide an opportunity for these individuals to participate in and benefit from Medicare Part D Plans. Low income individuals receiving a subsidy, similar to those dually-enrolled in Medicare and Medicaid, are expected to participate in the most basic plans offered in order to receive a complete subsidy and fully reimbursed premium. Subsidy coverage varies dependent upon the income level of the participant.

The benefits of Medicare Part D Plans are available to all Medicare enrollees, providing an affordable means of access to life-sustaining and health-ensuring prescription medication. The large number of plans available is tailored to meet the needs of every senior, ranging from those requiring expensive daily medications to those who require only occasional health maintenance medicines. With affordable premiums provided private insurers, plans are designed competitively to attract and retain the highest level of beneficiaries. The arrival of these Medicare Part D Plans has reduced the number of seniors who are unable to afford their prescriptions, or are forced to make other sacrifices to afford the medicines that they need.