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Medicare Part D Prescription Drug Plans: Costs and What's Covered

October 17, 2007 / 2:30 PM EDT / WebMD

or premium -- to stay in the program.
The fee varies by plan and region.

You also pay a yearly deductible. This fee varies depending on your plan,
but cannot be higher than $265 in 2007. After you have paid the deductible out
of your own pocket, your Medicare prescription drug plan kicks in.

Then, when you buy medications, your plan covers some of the costs.
But in some plans, there is a gap in coverage. This is called
the "doughnut hole." Once you've spent $2,251 on
prescription drugs (in one year), Medicare stops paying a share of the cost.
You have to pay the next $3,600 on your own. After that point, the plan kicks
in again and pays 95% of the costs.

You have to pay the remaining 5%. The total amount you pay each year on
medicine can vary a great deal -- depending on the drugs you need and the
dosage

But keep in mind that your plan may not be like this. Plans vary in terms of
their deductibles, co-payments, and coverage in the "doughnut
hole."

What If I Can't Afford a Medicare Part D Prescription Drug Plan?

Some people with low incomes and limited assets will be granted "extra
help" to pay for their Medicare drug plan. If you qualify, you may not have
to pay the monthly fee and your co-payments will be cheaper when you buy
drugs.

If your resources are less than $11,710 (single) or $23,410 (married) and
your income is limited, you may qualify for extra help paying for Medicare
Prescription Drug Coverage. These resource limits are for 2007 and may increase
each year. The resource limits include $1,500 per person for burial expenses.
Resources include your savings and stock, but not your home or car.

You may get an application for extra help in the mail. Or you can apply by
calling Social Security at (800) 772-1213 or using their online application .

People automatically qualify for extra help if they have both Medicare and
Medicaid ("dual eligibles"), get help from Medicaid in paying Medicare
premiums, or get Supplemental Security Income.

Remember: Even if you don't have a low income or limited assets, you
can still join the Prescription Drug Plan.

Medicare Part D: What Else Do I Need to Know?

If you don't sign up for the drug plan during your initial enrollment
period -- usually within three months of your 65th birthday -- but enroll
later, you may pay a penalty in the form of higher monthly
payments. Even if you don't need the drug coverage right now, you might still
choose to sign up for it anyway to avoid this penalty in the future.
There are exceptions. If you have drug coverage now that is as good as
Medicare's or better, you won't be charged a late penalty if you sign up later.
Call your insurance company for more information.

Even if a drug you need is supposed to be covered by your Medicare drug
plan, check the details. Some people find that their plan won't cover the drug
at the higher dosage they need.

If you have drug coverage from an employer or a union already, compare your
current policy with Medicare's prescription drug plan. Remember: If you
drop your current plan, you might not be able to get it back. So don't
make any hasty decisions.

For more information, see the Medicare web site at www.medicare.gov
or call 1-800-MEDICARE.

By
Reviewed by Brunilda Nazario
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