Back in 2006, the federally funded national health insurance program called Medicare began covering many prescription drugs participants took at home. The program introduced the Part D drug plans that are actually administered by private insurance companies. The basic requirement for participating in a Medicare Part D Coverage plan is to be eligible to join Medicare part A or B and be enrolled in Medicare Part B in order to join a Medicare Part D Coverage prescription drug program. It can be a stand-alone plan that a participant purchases in order to supplement Medicare part A and Part B coverage or can enroll in coverage provided by Medicare Part C, the Medicare Advantage managed care program.

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Enrollment is Voluntary

Participation in a Medicare Part D Coverage plan is voluntary and about 55 percent of the population that is eligible has enrolled in such a program. There are penalties imposed for people who do not enroll when they become eligible, which is usually at age 65. Participants who enroll at a later date will pay a 1 percent per month increase in premium for every month that they did not enroll. This higher premium cost applies to any plan selected and becomes permanent.  A participant in Medicaid is automatically enrolled in the low-cost Medicare Part D Coverage plan when they become age eligible.

Private Insurance Runs the Plan

The federal government will set rules and regulations for any Medicare Part D Coverage drug plan, but it will be private insurance companies that sell the plan to individuals and administer the plans on their own. There are many different plans available and they may vary from state to state. Some of these plans are considered stand alones. This means that the plan will cover prescription drugs only, complementing insurance held by participants in both Medicare Part A (hospital) and in Medicare Part B (doctor office). People who replace coverage available in Medicare Part A and B witha Medicare Part C Advantage managed care can receive drug payment coverage through this plan instead of taking out a Medicare Part D Coverage drug plan.

Monthly premiums are paid for coverage

The private insurance company will set the terms of coverage and payment for anyone receiving a Medicare Part D Coverage drug plan and these are only subject to the general rules provided by Medicare. Enrollment is done directly with the company and not through the federal government. Monthly premiums for participants and a Medicare Part D Coverage drug plan page typically from $10-$75 which will be dependent upon the type of plan one chooses as well as where one lives. The average plan cost is about $25 per month and some plans have no premiums at all. A good rule of thumb to remember is that the plans with the greatest amount of coverage possessing the lowest co-payments are going to demand higher monthly premiums.

What Drugs are Paid for Under a Medicare Part D Coverage Plan?

There is not any one plan that will cover every single drug. There are certain drugs that are restricted by law prohibiting any kind of payment through many insurance programs and are typically a list of prescribed sedatives, tranquilizers or sleeping pills. Prescription drugs for weight loss or over-the-counter medicines are not covered. They do require that each plan covers two types of drugs that are either brand-names or generic and must be in the therapeutic medication class. What this means is that the drug must be prescribed for treatment of a disease or condition. However, each Medicare Part D Coverage drug plan provides a list of medications that are covered in the plan. The plan will only pay for the drugs listed to a recognized pharmacy that agrees to participate in the plan. Unfortunately, these drug lists change from year to year. Participants may find one particular year that all of their drugs are covered, and in the next year many may not be. The Medicare Part D Coverage drug plan list, called a formulary, changes every fall with announcements about what specific drugs will be covered for the next calendar year. It is important for participants to make an annual review when the plan announces the participating drugs for the coming year in order to make a switch of plans if the medications needed and not on that list.

Additionally, individual Medicare Part D Coverage drug plans may require different co-payments for different drugs.