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Lesson 08: Medicare Part D (prescription coverage)

Medicare Part D

As part of the Medicare Modernization Act of 2003, a prescription drug benefit was available under Medicare beginning January 1, 2006.

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you`re first eligible, and you don`t have other creditable prescription drug coverage, or you don`t get Extra Help, you`ll likely pay a late enrollment penalty

To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

Facts About the Medicare Drug Benefit:

  • Pays for generic and brand name drugs
  • Everyone with Medicare is eligible
  • This is a voluntary program
  • You must join a drug plan to get the benefit (premiums and deductibles apply)
  • There is "Extra Help" for those with limited income
  • You may have a penalty if you do not join a drug plan when you are first eligible

How to Get the Medicare Drug Benefit:

  • Join a Private Drug Plan (PDP) to be used with Original Medicare
  • Join a Medicare Advantage Plan (HMO, PPO, PFFS) that also has drug benefits
Both types of plans are called "Medicare drug plans."  In either case you must live in the service area of the Medicare drug plan you want to join.



When Can You Join a Medicare Drug Plan?

  • Between October 15--December 7, anyone can join, switch, or drop a Medicare drug plan. The change will take effect on January 1 as long as the plan gets your request by December 7.
  • When you`re first eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of disability, includes your 25th month of disability, and ends 3 months after your 25th month of disability. You`ll have another chance to join that starts 3 months before the month you turn 65 ends 3 months after the month you turn 65.
  • If you get Extra Help, you can join, switch or drop a Medicare drug plan anytime.

Special Enrollment Periods

You generally must stay enrolled for the calendar year. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans at other times:

  • If you move out of your plan`s service area
  • If you lose other creditable prescription drug coverage
  • If you live in an institution (like a nursing home)

How to Join a Medicare Drug Plan

Once you choose a Medicare drug plan, you may be able to join by:

  • Enrolling on the plan`s Web site or on
  • Completing a paper application
  • Calling the plan
  • Calling 1-800-MEDICARE

When you join a Medicare drug plan, you`ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

Click here for information about dropping or switching Part D plans. 

How to Choose a Drug Plan

  • Gather all personal information including a list of medications with dose and frequency taken
  • Get information about what plans cover your drugs at the best price and have the pharmacy you use in their network (Get help at
  • Make your decision on cost, coverage and convenience of your own pharmacy choice
Use Medicare`s Plan Finder to find and compare drug plans available in your area.


Help paying for prescriptions and prescription coverage.

If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare prescription drug coverage. You may also be able to get help from your state.


The Donut Hole

Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there`s a temporary limit on what the drug plan will cover for drugs.

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.

Once you enter the coverage gap, you get a 50% manufacturer-paid discount on covered brand-name drugs. Although you`ll only pay 50% of the price for that brand-name drug, the entire price will count as out-of-pocket spending, which will help you get out of the coverage gap.

You`ll also save 7% of the plan`s cost for all generic drugs until you reach the end of the coverage gap.

Items That Count Towards the Coverage Gap

  • Your yearly deductible, coinsurance, and copayments
  • The discount you get on brand-name drugs in the coverage gap
  • What you pay in the coverage gap

Items That DON`T Count Towards the Coverage Gap

  • The drug plan premium
  • What you pay for drugs that aren`t covered
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MB Senior Solutions

9080 Springboro Pk
Miamisburg , Ohio  45342
Phone: 1-877-222-1942
Phone Extension: N/A
Area(s) Served: Butler County,
Warren County,
Clermont County,
Clinton County,
Hamilton County
Contracted Provider: Not Applicable
Description:   MB Senior Solutions was formed in 2007 to provide Medicare-eligible individuals with the knowledge, guidance and choice needed to select a Medicare plan that is right for their specific needs. Today, MB Senior Solutions is one of the largest independ... read more
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Centers for Medicare & Medicaid Services
Baltimore , MD  21244-1850

Phone: 1-800-633-4227
Phone Extension: N/A
Area(s) Served: Nationwide Contracted Provider: Not Applicable
Description: has all of the information and tools you need for questions or help with Medicare. You can: enroll in Medicare online compare and enroll in Medicare health or prescription plans find and compare doctors check to see if a test... read more

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