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What is Medicare Prescription Drug Coverage?

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  • Written By: wiseGEEK Writer
  • Edited By: O. Wallace
  • Last Modified Date: 16 July 2019
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Medicare prescription drug coverage is a fairly new and often optional part of Medicare services. It is also called Medicare Part D, and availability of this coverage began in 2006, with first enrollment beginning in the last two months of 2005. Traditional Medicare, parts A (hospital) and B (medical) don’t have many provisions for covering prescription medicines, though they may cover a few, and this created significant financial burden for some seniors. Medicare prescription drug coverage allowed a number of private insurers to come in and offer some drug coverage to seniors, which in some cases could be augmented by subsidies when seniors are very low income.

There are many Part D plans to choose from and they each may have different ways of assigning benefits. A number of these plans assess several hundred dollars in deductible fees before they begin prescription drug coverage, though a few may begin by offering copayments on drugs. Price of a plan, types of drugs covered, and plan pricing of drugs varies by plan. This might make choosing a plan pretty difficult, though the Health and Human Services website may be of help in learning about Part D and making choices on specific plans.

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There usually exists an early deductible with the plan, that is a couple hundred dollars, and then people may pay a percentage (coinsurance) or a copayment. Medicare participants also need to look at a higher-level deductible or plan spending limits. Once people reach several thousand dollars of spending, they may reach the end of coverage for the year, particularly if they are not low income. Given the price of medications, a complex and chronic medical illness might easily reach this limit, and approximately one in four people run out of coverage before years’ end

Part of this problem may be due to the way the Medicare Prescription Drug, Improvement, and Modernization Act was written. Many feel that Medicare prescription drug coverage was particularly undercut by the fact that its legislative terms quite specifically made it impossible for the federal government to work with pharmaceutical industries to lower or standardize drug prices. The fact that the government can in no way control amounts of costs, means costs are high for seniors and insurers who offer the plans. Some people choose not to get Medicare Part D, due to the fact that it may represent little savings, though those people who take many prescription medications usually require this coverage to at least meet part of their costs.

An alternative to Medicare prescription drug coverage is participating in Part C or a Medicare Advantage Plan that offer prescription drug benefits. There are numerous plans that work like HMOs or PPOs and allow people access to prescription drugs right away without necessarily charging a deductible. It should be noted that not all Part C plans offer Medicare prescription drug coverage. Those enrolling in Medicare should definitely compare plans and read all fine print to determine level of coverage. If a Part C plan covers drug benefits, there is no need to enroll in a Medicare prescription drug coverage or Part D plan too.

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