What is Medicare Part D?

What is Medicare Part D?

Yesterday, “What is Medicare Part D?” I was asked. So I thought I’d go ahead and write an article about it. So if you are wondering what the Part D in Medicare is, You are in the right place.

What is Medicare Part D?, Part D is For drugs, Medicare Part D is A Prescription Drug plan

Medicare Part D is one part of the federal social insurance program administered by the Social Security Administration. The plan has four parts, Part A, Part B, Part C and Part D.  In case you are wondering which social insurance program that could be it is Medicare.

Some people get upset when they see the word social. They automatically think socialism. To a degree that is exactly what it is. A contribution by many for the common good. Even I can accept the premise.

What is not acceptable is how the government politicizes this program. To me, we are talking people’s lives and Medicare has been a god send for millions. Take the pure, raw politics out of the system and administer it per mandate.

What is Medicare Part D?

The Answer is Drugs

Part D is the part of this program aimed at drugs. Not the back alley kind but prescription drugs. The kind you get at a pharmacy. An eligible beneficiary can enroll in a standalone Part D insurance plan or through a Medicare Advantage Plan which is Part C of Medicare. And none of these have anything to do with “Medicare For All”, yet. Fortunately.

Don’t let all the Parts throw you off. Simply follow the bouncing ball and you’ll understand the program. Sometimes I think the government tosses out all those numbers and letters simply to confuse the participants.

To be eligible, a person must be within 3 months of their 65th birthday, in their 65th birth month or 3 months after their 65th birthday. This gives them 7 months to enroll. The person must also be enrolled in Part A & Part B. Part A & Part B are referred to as original Medicare.

Original Medicare Explained

They are called original Medicare because up until 2003 Medicare only had Part A & Part B. Part C and Part D followed in ensuing years.

If you do a quick search on Google you will find this explanation of Original Medicare:

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

– Explanation on Google SERP(Search Engine Return Page)

That’s easy to understand. If you were on Medicare prior to 2003 you experienced the program first hand. C & D were meant to lighten the load on the Medicare recipient.


Acronyms Are The Mainstay of Government Programs

Because Medicare Part D’s sole function is a prescription drug plan, it goes by the acronym PDP. Medicare contracts with private insurance plans to provide the prescription drug (PDP) benefits.

If you are a person with a Medicare Advantage Plan that includes drug coverage, it goes by the acronym MAPD. Regardless of which plan you own, there are costs you will have to pay. These costs include, but are not limited to, deductibles and co-pays plus Part D does not cover all medications.

If you have an MAPD, you have all of your insurance benefits in one policy. On the other hand, a person with just a PDP, may have one company for their Part A & Part B supplemental coverage while having another company provide their Part D coverage.

Who Provides What and Who Pays For It

Part A & Part B are provided by the federal government. Part C & Part D are provided by private insurance companies. Before a person can buy an MAPD, they must be enrolled in both Part A & Part B.

If a person misses their initial eligibility enrollment period, they will have to wait for what is called the open enrollment period. November 15 through December 31 of each year has been designated as the dates of the open enrollment period.

In addition, if a person misses their initial eligibility period and enrolls during the open enrollment period, a penalty in the form of higher premiums is assessed by Medicare against the individual. However, a person never has to enroll in Part D so the penalty could be moot for some people.

Part D also has an annual coverage limit. Once a person spends an amount that equals the annual coverage limit, they become subject to another deductible called a coverage gap. During this time period, the beneficiary pays all costs for drugs up to an annually set amount. This amount changes each year so pay attention to your plan.

Some Quick Final Thoughts

The good news is that once a person reaches this set amount, both generic and preferred drugs are available at set prices for the remainder of the year. The bad news is that when January 1st rolls around the next year, all of the deductibles and limits must be met again.



Senior Outreach Ministries achieves it’s objectives with the capital we’ve either earned or received from donors. The Proud 2 B A Senior Ribbon for example. Donate $5, get a ribbon and help us help a hungry Senior Citizen in need. All proceeds remain in the Ministries to be used per our mission statement. We are a volunteer church. No one receives a salary or wage. Please help us help less fortunate hungry Seniors. We never have and never will ask the government for grants, funds or hand outs. Thank You in advance.

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Medicare For All a.k.a. Promises, Promises

Medicare For All a.k.a. Promises, Promises

Medicare for all is in the news, again. With every Democratic politician promising to have such a program in force during their presidential administration. That is easier said than done. Keep in mind, tinkering with these resources for seniors isn’t as easy as what sounds good.

The obvious stumbling block is one of those candidates has to first be elected. But, whether they are or are not is not the focus of this article.

The second most obvious stumbling block is the definition of Medicare for all. A person would not think there could be more than one definition. They would be wrong. After all, this isn’t really about seniors and their health.

A look at the proposals says there isn’t one, two or three, there are multiple definitions. The candidates are on record stating their position. The easiest way to learn the multiple definitions is to google each candidate. Their platform is laid out on their website.

For example, one proposal calls for the elimination of private health insurance companies. This sounds good and may even look good on paper but the reality is exactly the opposite.

Why?

The private health insurance companies are the providers of record for Medicare Advantage contracts, Prescription Drug Coverage and much of the bill processing for the entire program. This means just the claims processing portion of Medicare would be severely impacted.

No one has anything to say about rectifying all the errors that would arise with the private health insurance companies completely eliminated from the Medicare landscape. Neither has the denial of service aspect been addressed with the removal of the private sector.

Couple this scrambled egg proposal with the single payer concept. The government would be responsible to pay for all of the health care. However the doctors, hospitals and other health care providers would remain private. Imagine the Mardi Gras atmosphere under that scenario.

Throw in the public option system and another set of holy cows enters the picture. Would this option be open only to people over a certain age? Would it be open to all consumers buying coverage through a public exchange? Is there be a cap on premiums?

Final Thoughts

You do not have to be a rocket scientist to conclude the Medicare for all suggestion is still a suggestion designed to get votes and campaign contributions. Should this concept be taken seriously?

The answer is probably yes given the rapid advancements being made in medicine. Unfortunately the how to pay for this program still has way too many bugs. Medicare for all may indeed be the solution to the health insurance coverage in the United States. But the bottom line is It needs serious committed minds to flesh it out.



Senior Outreach Ministries achieves it’s objectives with the capital we’ve either earned or received from donors. The Proud 2 B A Senior Ribbon for example. Donate $5, get a ribbon and help us help a hungry Senior Citizen in need. All proceeds remain in the Ministries to be used per our mission statement. We are a volunteer church. No one receives a salary or wage. Please help us help less fortunate hungry Seniors. We never have and never will ask the government for grants, funds or hand outs. Thank You in advance.

Original Medicare New App: What’s Covered

Original Medicare New App: What’s Covered

Original Medicare has a new trick up it’s sleeve. And, it’s a good one. The Centers for Medicare and Medicaid Services (CMS) has joined the 21st century with their new app. It’s called “What’s Covered”.

Consumers will now experience direct access on a mobile device. And access to some of the most used content on Medicare.gov. So, recipients and caregivers, can quickly see whether Medicare covers a specific medical item or service. And how much it costs.

And what this means to consumers is astonishing. A patient at their doctor’s office will get accurate coverage information. In real-time nonetheless. And the same holds true for hospital patients. Or anyone else with a mobile device anywhere they happen to be.

And the app doesn’t replace Medicare.gov or their toll free number, 1-800-MEDICARE. So, people without mobile devices can still get the information they seek. Having what original Medicare covers at you fingertips, makes life easier and quicker. But it doesn’t make it a replacement tool.

CMS is busy implementing new tools. Because it’s tough for seniors to figure out their coverage. Not to mention out of pocket costs. A new online service lets people quickly compare different coverage choices. And see how it will affect their out-of-pocket expenses for example.

There’s also new price transparency tools. Because this helps consumers compare the national average costs of certain procedures. And this is in addition to the new app displaying what original Medicare covers. Because we are dealing with important information. 

Another new added tool is a web chat option. It’s located in the Medicare Plan Finder. All the new tools come under the eMedicare initiative. This program is focused on modernizing Medicare. And, at the same time, empowering patients with information. So they get the best value from their coverage.

Original Medicare is Growing Exponentially

Medicare enrollment is expected to grow from approximately 54 million current beneficiaries to 80 million beneficiaries by 2030. And these new beneficiaries are already technology savvy. I wonder what happens when Medicare For All comes to fruition. If it ever does.

The new app displaying what original Medicare covers should be a walk in the park. So, when all the proposed initiatives are adopted, these folks will enjoy an information explosion unheard of.

And the most surprising aspect of these initiatives? It’s the fact they originate from an agency with the reputation of an old stodgy government organization. Not to mention, one that moves at the speed of rust. These times change and apparently they are changing for the better.

You can get the app for free from both Google and Apple. Visit the respective website and download the app for you:

Google Play

https://play.google.com/store/apps/details?id=gov.medicare.coverage&hl=en_US

Apple App Store

https://itunes.apple.com/us/app/whatscovered/id1444143600?mt=8

The new app displaying what original Medicare covers is just the beginning for the soon to be senior citizen of the future. The person Senior Outreach Ministries ordained as a pre-sene.



Senior Outreach Ministries achieves it’s objectives with the capital we’ve either earned or received from donors. The Proud 2 B A Senior Ribbon for example. Donate $5, get a ribbon and help us help a hungry Senior Citizen in need. All proceeds remain in the Ministries to be used per our mission statement. We are a volunteer church. No one receives a salary or wage. Please help us help less fortunate hungry Seniors. We never have and never will ask the government for grants, funds or hand outs. Thank You in advance.