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.

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