What is a Part D Prescription Drug Plan or PDP?
What does a Part D Plan cover and why should you get one if most Medicare Advantage plans have prescription coverage? If you want prescription drug coverage at a manageable cost than a senior has 3 options:
- Enroll in a Medicare Advantage plan that contains Part D Prescription drug coverage also known as a MAPD. The plan can be an HMO or PPO.
- Enroll in a Private for Fee Service plan (PFFS) that has prescription drug coverage built into it
- Enroll in a Part D stand alone plan
A PDP must have a minimal level of coverage dictated by CMS.
- A deductible of $360 must be met by the senior every calendar year
- Pays 25% of the costs between $360 and $3310 (which is $738)
- Pays for 58% of generic drug costs and 45% of brand name drug costs
- Once beneficiary expenditures (including drug manufacturer discounts) reach a total of $4,850, the beneficiary is through the coverage gap and reaches catastrophic coverage. On any future prescriptions the beneficiary pays either a co-pay of $2.95 for generic drugs or $7.40 for brand name drugs or a co-insurance of 5%, whichever is greater.
Majority of seniors who get a Part D prescription drug plan do so because they have a Medigap or Medicare Supplement plan and they need a plan that covers their medication. Medicare Supplemental health insurance doesn't cover prescription drug needs anymore, and if seniors want to get their prescription drugs (and avoid the part d penalty for not having continuous credible prescription drug coverage) they will get a separate Part D drug plan.
Who Is Eligible For a Part D Plan?
Only seniors who have enrolled in either Part A or Part B Medicare may enroll in a stand alone Part D Plan. You do NOT have to taking Social Security to enroll in ANY Medicare plan, there is a misconception that you have to be enrolled in Social Security Retirement Benefits to enroll in a part D plan because one of the payment options for a Part D Plan is for the company to take it out of your Social Security check.
The other requirement to enrolling in a PDP is to be living within the plan's service area and have access to pharmacies in the network.
NO COMPANY CAN REJECT APPLICANTS BASED ON HEALTH (UNLESS YOU HAVE RENAL FAILURE OR A CHRONIC CONDITION THAT WOULD BE BETTER COVERED UNDER A SPECIAL NEEDS PLAN
How Much Does a Part D Prescription Drug Plan Cost?
Due to minimize standards set by Medicare, plans must contain minimim
CAUTION: SENIORS CANNOT HAVE BOTH A MEDICARE ADVANTAGE PLAN AND A PART D PRESCRIPTION DRUG PLAN (PDP)!