Medicare Part D Insurance explained. Who qualifies for Medicare Part D and what are the limitations. The medical billing specialist doesn’t really have any involvement in Part D insurance reimbursement, but I did want to explain the different components of Medicare coverage.
Medicare Part A & B Eligible
Medicare Part D covers prescription drug costs. Anyone enrolled in Medicare Part A or B is eligible for Medicare Part D. This drug insurance coverage was created by the Medicare Prescription Drug, Improvement, and Modernization Act in 2003. There was a lot of confusion when the plan was first implemented in 2006.
To receive Part D prescription coverage, a person with Medicare must enroll in a stand-alone Prescription Drug Plan or Medicare Advantage plan with prescription drug coverage.
The Donut Hole
The above link includes more information on the Donut Hole gap in Part D prescription drug coverage. This is the gap or difference between the initial limits of insurance and the catastrophic Medicare coverage for prescription drugs.
Administered by Private Carriers
While these plans are regulated by Medicare, they are arranged and administered by private health insurance providers. Individuals who join a Medicare drug plan pay a monthly premium and have an annual deductible depending on the plan chosen. Part D coverage differs from Part A and Part B in that there is no standardization to Part D. Each plan has different coverage for which drugs (or class of drug). Some drugs may not be covered at all.
For beneficiaries covered by both Medicare and Medicaid, Medicaid may cover the cost for drugs not covered by part D of Medicare insurance. Those who decline coverage when first eligible may have to pay a penalty if deciding to enroll at a later date.