Your Guide to Medicare Part D

Medicare Part D was created by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), and coverage began January 2006. The program has the potential to save Medicare Beneficiaries (those 65 and older or those with disabilities) a considerable amount of money, depending on their drug usage.

But choosing and enrolling in a plan is a complicated process, and many people have questions along the way. Once you’re enrolled in the program, changes in your medications or other situations may lead to additional questions. The purpose of this guide is to help you navigate the system so you can get the most of this important benefit. Here are some highlights of what you’ll find inside:

• If you are a Medicare beneficiary you can purchase prescription drug coverage through Part D regardless of your health status, prescription drug use, or income. If you recently became eligible for Medicare (for example, if you just turned 65), the next enrollment period will be from November 15 to December 31, 2006. For an introduction to Medicare Part D, go to page 6.
• The way that Medicare drug coverage works depends on your current plan. Therefore, you should review your current health insurance including any coverage you get from retirement or veteran’s benefits.  To learn how to evaluate your current plan and what that means for enrolling in Part D, go to page 8.
• Part D plans cover some but not all medically necessary prescription drugs on the market today. This means that certain plans may pay for some but not all of the drugs you take. For more on how to determine which plan is best for you, go to page 12. There are also worksheets on page 34.
• Most Part D prescription drug plans have a gap in their coverage, and during that time, called the “donut hole,” you still must continue paying monthly premiums even though your drugs are no longer being paid for by the plan. For more on the donut hole and tips for avoiding and dealing with this gap in coverage, see pages 9 and 13-15.
• If your plan denies coverage for a certain medication that your doctor says you require, you can file for an exception. For more on exceptions, grievances, and appeals, see page 24.

Many organizations offer information and assistance for researching and enrolling in Medicare Part D. For a list of resources, see page 32.