Medicare Part D

Medicare Part D is a part of the federal government’s health care (Medicare) program enacted under the “Medicare Prescription Drug, Improvement and Modernization Act of 2003” which took effect on 01 January 2006. Part D is specifically intended to subsidize the prescription medication costs for beneficiaries of Medicare in the US.

To be eligible for Part D coverage, an individual must be entitled to benefits or enrolled in either Medicare Part A or B, or both. Beneficiaries can avail of benefits under the prescription drug coverage via two private plan types. They have the option of obtaining any Prescription Drug Plan (PDP) only for drug coverage or a Medicare Advantage (MA) plan covering both medical services as well as prescription drugs (MA-PD). MA-PD is actually the Part C of Medicare.

Approximately 2/3 of beneficiaries of Part D opt for the PDP route. Because drugs are covered at various levels, members have the advantage of choosing some specific drugs over similar alternatives. This system is generally implemented through tiered formularies where the less expensive medicines are designated to the lower tiers that make them even more affordable and easier to prescribe.

People with dual eligibilities or those who are also entitled for prescription drug benefits under Medicaid have been transferred to Part D coverage effective 01 January 2006. They are given automatic enrollment to any of the lower cost PDP’s in their respective areas that have been randomly selected. If the dually eligible individuals already have MA-PD coverage, they are disqualified from MA coverage automatically upon membership to a PDP plan.

To be able to participate in Part D, Medicare members are usually required to confirm their enrollment. The annual period for enrollment begins on November 15 and concludes on December 31 each year. However, effective 2011, the enrollment period will now be from October 15 up to December 7. Eligible Medicare beneficiaries who fail to make it within the enrollment period can still enroll for Part D coverage by paying a late enrollment penalty or LEP. The LEP is computed as 1% of the nationwide average premium multiplied by the number of full months of eligibility where no enrollment was made.

As of April 2010, there are 27.6 million Medicare Part D enrollees to about 1,576 stand alone prescription drug coverage plan options. This is slightly down from 2009’s 1,689 plans. Hawaii and Alaska offer the fewest plan choices at 41while West Virginia and Pennsylvania have the most plan options of 55 apiece. Because of the numerous plans available, individual members have the option to select the best plans that meet their particular needs.

The various plans are mandated to provide standard benefits or their equivalent from an actuarial point of view. They are, however, allowed to provide bigger and more generous offers. To make the selection process even more convenient for members, Medicare has put up an online interactive tool known as the Medical Plan Finder. This makes comparison of various Medicare Part D plans in terms of cost and benefits for each geographical area easy.

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