Prescription Pills Insurance: Who Is Eligible for Medicare Part D?

Medicare insurance ensures seniors and those with disabilities can access affordable health insurance to cover medical expenses. While the premise of the federal health insurance program is simple, it is divided into different parts, which can be confusing for consumers as they figure out what is covered and who is eligible. The four parts of Medicare are known as A, B, C, and D, which cover all aspects of insurance coverage. Part D provides prescription drug coverage and is run by Medicare-approved private insurance companies. But who is eligible for Medicare Part D? With Medicare open enrollment now underway, consumers need to understand eligibility and coverage options, which we will cover below.

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What Is Medicare Part D and How Does It Work?

Medicare Part D went into effect in 2006 to provide an optional prescription drug benefit for Medicare recipients. As the costs of Medicare and prescription medications increased, Part D was enacted to help Medicare beneficiaries afford the increased prices. It is an optional benefit of Medicare provided by private insurance companies approved by Medicare rather than directly by the government. Each plan has a list of covered drugs, usually divided into different cost tiers. Those interested in the coverage typically pay a monthly premium, an annual deductible, and copayments or coinsurance for their prescriptions.

What Makes You Eligible for Medicare Part D?

Those receiving Medicare insurance must be enrolled in Medicare Part A and/or Part B to be eligible for Medicare Part D. To enroll, interested consumers must complete an enrollment request during an open period. Enrolling in Part D can take place during the Initial Enrollment Period (IEP) for the consumer, which is a seven-month period that begins three months before the month they turn 65, includes their birth month, and extends three months after. If they miss this time period, they can enroll during the Annual Enrollment Period, which is underway until December 7.

Is There a Deductible for Medicare Part D?

Medicare Part D plans typically include a deductible, which is the amount consumers pay out-of-pocket for their prescription drugs before their plan begins to cover the costs. While the exact deductible number can vary depending on the plan chosen, the maximum deductible allowed by Medicare for Part D plans is $545. Many plans set their deductibles lower than $545, while some apply the deductible only to certain tiers of drugs, like brand-name medications. Others may only pay a copayment or coinsurance for lower-tier drugs before meeting the deductible. The deductible will reset each year, so consumers must pay it again at the beginning of each plan year.

What Is the Difference Between Medicare Part A and D?

While Medicare coverage for Part D involves the prescription drug medication aspect, Part A is the main component providing insurance for inpatient hospital stays, nursing facility care, hospice care, and some home health care services. Part A usually does not have a premium for beneficiaries who have paid Medicare taxes for at least 10 years while working. While Part A is essential since it covers inpatient and some outpatient care, Part D is optional for those looking to lower the costs of their prescription medications.

HealthPlusLife Can Clarify Who Is Eligible for Medicare Part D

Knowing who is eligible for Medicare Part D is extremely important for consumers during open enrollment. Medicare recipients should always review their Part D options annually during the open enrollment period, as plans can change their costs and coverage annually. To help consumers choose the best health insurance coverage for their needs, HealthPlusLife aims to help Medicare recipients access the best coverage options for their healthcare needs. Our goal is to help consumers make informed decisions that meet their budget when choosing health and life insurance policies. Navigating the insurance market can be complicated for consumers without the proper knowledge and resources. For consumers looking to explore the various Medicare health insurance options available to them, HealthPlusLife offers the professional support needed to make the right decision. Please call us at 888-828-5064, TTY 711, to get started today.

External Source

• Centers for Medicare & Medicaid Services — CMS’ Program History
• Medicare.gov — Explore Your Medicare Coverage Options
• Medicare.gov — Yearly Deductible for Drug Plans