Quick summary
In 2006, Medicare began covering some prescription drugs taken at home. It introduced Part D drug plans, which are actually operated by private insurance companies with very little oversight by Medicare itself.
Here are the basics you need to know about Medicare Part D prescription drug plans:
Who's eligible for Medicare Part D coverage?
Anyone who is entitled to join Medicare Part A or enrolled in Medicare Part B can join a Medicare Part D prescription drug plan. This can be a stand-alone plan that complements Medicare Part A and Part B coverage, or it can be part of a Part C Medicare Advantage managed care plan that rolls together hospital, medical, and prescription drug insurance.
Enrolling in a Part D plan is voluntary for most people; about 55 percent of those eligible for the plans have enrolled in one. If someone doesn't enroll when first eligible for Medicare (usually at age 65) but later does join a plan, he pays a penalty of 1 percent per month on the premiums for every month he's delayed. This higher premium cost applies to any plan he enrolls in, and it's permanent.
If he receives Medicaid (Medi-Cal in California) benefits, he's automatically enrolled in a low-cost Part D plan.
Who runs the Part D drug plans?
The federal government's Medicare program sets the basic rules for Part D prescription drug plans, but private insurance companies issue the individual plans themselves. Different plans are offered in every state. Some are called stand-alone plans, meaning they cover prescription drugs only and complement separate coverage under Part A for hospital insurance and Part B for medical insurance. People who opt for a Part C Medicare Advantage managed care plan can get Part D drug coverage through that plan instead.
The specific terms of payment and coverage are set by the company issuing the Part D plan, subject only to Medicare's general rules. If someone wants to enroll in a plan, he does so directly with the insurance company that offers it, whether it is a stand-alone Part D plan or part of a Part C managed care plan.
I've been a Part D participant since the program began. Part D hasn't helped me at all. Prior to Part D, the insurers providing Medicare Part B, offered supplementary prescription drug coverage options. The premium cost for these drug coverage plans was approximately the same as that of Medicare Part D. The difference is that the pre-PART D Plans put a cap limit on annual coverage. However the limited annual coverage was between $1800-$2200 per year; which was a much higher amount, than was the low end of the Medicare Part D Prescription coverage doughnut hole, when the plan went into effect. And this was more than 5 years ago so, undoubtedly, left alone without Govt meddling, the coverage amounts would have increased by now. Hence, the free market provided a better coverage for less money than Medicare Part D, to individuals like me, who pay more than average for drugs per annum, but less than someone requiring catastrophic prescription drug coverage. Today, my total out of pocket prescription drug costs, are more for the same medications, than they would have been if the Government had never created Medicare Part D. I realize that some people, probably most people have benefited greatly from Part D, however, I have not. I’ve been damaged and the fact that I am now trapped, without a better available option; is further proof of how Government, by definition can never adequately provided for the individual citizen.
First call Medicare & ask for advice, you should also contact the maufacturer of the drugs you need & see if they'll help you. Good luck
I am 60 years old and drawing my exs social srcurity.It they put me on medicare and it leaves me paying $122.00 of my meds.I don"t have enough money to get my meds. I am a diabetic and take insulin and other meds. without these I could die.What can I do?