Medicare Prescription Drug Benefit
(Part D)
Medicare Prescription Drug Benefit
The
Medicare Prescription Drug Benefit provides coverage that helps
persons on Medicare pay for the prescription drugs. It is available to
all people with Medicare and covers brand name and generic drugs.
Eligibility
In order to qualify for the Prescription Drug Benefit individuals
must be entitled to Part A and/or enrolled in Part B and elect to enroll
in the program. Learn more about Medicare. Enrollment
The initial enrollment period (IEP) for people entitled to Medicare
before February 2006 was November 15, 2005 - May 15, 2006. For people
entitled to Medicare in February 2006 or later the IEP is 7 months,
including 3
months before the month of entitlement, the month of entitlement, and 3
months after the month of entitlement. The annual coordinated election
period (AEP) is an enrollment opportunity for persons who previously
delayed enrollment or would like to change plans. A special enrollment
period (SEP) may apply in special circumstances.
Download a fact
sheet on Medicare enrollment
Download a one
page handout on enrolling in a Part D Plan
Penalty
People that are eligible for drug coverage but choose not to enroll
are subject to a penalty if enrolling at a later date. The penalty is equal to a 1% increase in
premiums for each month of delayed enrollment based on the national base
premium. Standard
Prescription Drug Coverage
Coverage under the Medicare Prescription Drug Program is generally
less than $37 monthly premium, has a $250 deductible, Coinsurance of 25%
of drug costs from $250 to $2,250, Medicare will pay 75%. An individual
will pay 100% of drug costs from $2,250 to $5,100. After $3,600 in
out-of-pocket costs, Medicare will pay approximately 95%. Extra
Help
The extra help is designed to provide people with limited income and
resources extra assistance with premium and cost sharing under the
Medicare prescription drug coverage. A person must enroll in a Medicare
prescription drug plan to receive extra help. People should apply for extra help using Social Security
Administration Application or by visiting
www.ssa.gov (Off Site).
Exceptions and Appeals
Learn more about Medicare's opportunities to appeal coverage
decisions made by health plans.
To learn more about the Medicare Prescription Drug Benefit and Extra
Help, contact the Senior LinkAge Line® at
1-800-333-2433 or visit Medicare at
www.medicare.gov
(Off Site).
Other Resources
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