Medicare Part D

Medicare Part D is a program that provides prescription drug coverage for people who are eligible for Medicare in the United States. It was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006.

Overview

Medicare Part D is optional and is offered by private insurance companies that are approved by Medicare. The program is designed to help people with Medicare pay for prescription drugs, including vaccines, biologicals, and certain medical supplies that are not covered by Medicare Part B.

Eligibility

To be eligible for Medicare Part D, an individual must be entitled to benefits under Medicare Part A and/or enrolled in Medicare Part B. The individual must also live in the service area of a Medicare Part D Pharmacy Benefit Manager (PBM).

Coverage

Medicare Part D coverage varies by plan, but all plans must cover at least a standard level of coverage set by Medicare. The standard benefit includes an initial coverage limit followed by a coverage gap (also known as the "donut hole"), catastrophic coverage, and a monthly premium.

Costs

The costs for Medicare Part D include a monthly premium, yearly deductible, copayments or coinsurance, and costs in the coverage gap. Some people may qualify for Extra Help, a program to help pay for these costs.

Enrollment

Enrollment in Medicare Part D is voluntary and is available during specific times of the year, known as enrollment periods. There are also special enrollment periods for certain situations.

Criticisms

Medicare Part D has been criticized for its complexity, the coverage gap, and the high costs of prescription drugs.

See also

• Medicare (United States)
• Medicare Part A
• Medicare Part B
• Medicare Modernization Act
• Prescription drug

Medicare Part D

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  Centers for Medicare and Medicaid Services logo
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  Part D Standard Benefit 2021
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  United States Per Capita Prescription Drug Expenditures, 1960-2019