Who ie eligible for Medicare Part D?
If you are entitled to Medicare benefits under Medicare Part A or enrolled in Medicare Part B; and you reside in the service area of the Medicare prescription drug plan - you are eligible for the Medicare Part D program.
Usually Medicare is available to people 65 years old and older, people who are under 65, but qualify for Medicare coverage, and people with End Stage Renal Disease (kidney failure).
How does Medicare Part A work?
Medicare Part A:
pays for inpatient hospital, skilled nursing facility, and some home health care. For each benefit period Medicare pays all covered costs except the Medicare Part A deductible ($1,600 in 2023) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
Medicare Part A premiums are charged on the basis of how many quarters of Medicare-covered employment. In fact, most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. For people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment, the Medicare Part A premium is $506 per month.
- Medicare Part A will cover your prescription medications that you need during your Medicare-covered hospital or skilled nursing facility stay.
How does Medicare Part B work?
Medicare Part B:
covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment. The Beneficiary pays 20% of the Medicare-approved amount for services after meeting the $226 deductible.
The 2023 monthly premium for Medicare Part B is $164.90 per month. The 2022 Part B premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account. This excess is being passed back to people with Medicare Part B coverage via reduced premium and deductible.
Click here to read the CMS Press Release on the 2023 premiums and deductibles.
- Medicare Part B will cover your prescription medications administered by your physician or dialysis facility, as well as some of your outpatient prescription drugs.
I am enrolled in a Medicare Advantage Plan (Medicare Part C), can I also enroll in a Medicare Part D plan?
Probably not - Always check with your Medicare plan administrator ...
Medicare Part C
, also known as a Medicare Advantage plan (previously Medicare+Choice), makes available Medicare-covered health care services through a Medicare private health plan, such as an HMO, PPO or Private Fee for Services plan. There are two variations of Medicare Advantage Plans, those with (MA-PD) and those without prescription drug coverage (MA). If you are enrolled in a Medicare Advantage plan that includes prescription drug coverage (MA-PD), you usually can not enroll in a Medicare Part D Prescription Drug Plan, unless you are a member of a Private Fee-for-Service MA Plan (PFFS) a Medical Savings Account MA Plan (MSA), or a 1876 Cost Plan.
» Click here to review 2023 Medicare Advantage Plans.» Click here to review 2023 Stand-Alone Medicare Prescription Drug Plans.
How can I choose between a stand-alone Medicare Part D plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)?
Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs).
Choosing how you receive Medicare drug coverage ultimately depends on your situation and personal preferences -
and whether you need only prescription drug coverage or you wish to have prescription drug coverage and additional healthcare coverage.
To help you make a decision, you might want to examine these two types of Medicare plan options based on:
- Coverage - Do you only need drug coverage? Do you already have a
Medicare Supplement or other Medical insurance?
You cannot use a Medicare Advantage plan with a Medicare Supplement. If you have healthcare through your employer, you probably do not want to enroll into a PDP or an MAPD
(or risk losing your employer coverage).
- Complexity - If you choose an MAPD, ask whether your drugs, pharmacies, doctors, specialists, hospitals all included within the plan's coverage or network?
If you rely on a certain group of healthcare providers, you may find that they are not included in your plan's network - and you will need to have approval to go outside of
the plan's network - and may pay more for out-of-network services.
- Availability - Is there a Medicare Advantage plan
available in your
(most Medicare Advantage plans are found in population-dense areas)? Is a PDP the only drug plan alternative
available for you? Do you have ESRD (kidney failure)
that would keep you from enrolling in a MAPD?
- Cost - Are you healthy and looking to avoid the
late-enrollment premium penalty?
If so, you may wish to just join a $0 premium Medicare Advantage plan (if available) that includes drug coverage (MAPD). If you are unhealthy or have chronic
health issues, a Medicare Advantage plan's
Maximum out of Pocket (MOOP)
limit may help contain your annual medical costs (albeit to around
$7,550, depending on the plan).
Need to read a little more about Medicare Advantage plans and stand-alone Medicare Part D plans?
Please see our Frequently Asked Questions (FAQs):
Can I be enrolled in more than one Medicare Part D plan?
You may be enrolled in only one Medicare Part D prescription drug plan at a time.
Many people are confused with the enrollment process and enroll in more than one Part D plan (thinking that they can use both plans). If you have enrolled in two stand-alone Medicare Part D plans, the most recent enrollment is probably effective and the first Part D plan enrollment will be canceled by your re-enrollment. If you are not sure if you are enrolled in a plan, contact the plan first before re-enrolling. When in doubt, you can also telephone Medicare (1-800-633-4227) and ask about your Medicare plan enrollment. Remember
, your Medicare plan will need about 10 business-days to process your enrollment, so make sure you give your Medicare plan a little time before checking on whether your enrollment was effective.
Medicare Part D and VA drug benefits
VA prescription drug coverage can work together with a Medicare Part D plan.
If you are entitled to VA health benefits, your coverage will not change when you are eligible for Medicare. If you decide that VA drug coverage meets your prescription needs,
you can choose not to join a Medicare drug plan.
VA prescription drug coverage is considered creditable drug coverage, which means it is at least as good as Medicare drug coverage. If you decide you want to join a Medicare drug plan after you are first eligible, you won't have to pay a
late enrollment penalty if you later decide to join a Medicare Part D plan.
Please remember, after the close of your
Initial Enrollment Period that if you want to join a Medicare drug plan,
you must wait for a valid enrollment period. Again, you will not have to pay a late enrollment penalty with VA drug coverage.