Understanding Medicare Drug Coverage

Health, Home & Family
on October 25, 2011

The Medicare Prescription Drug Coverage program, more commonly known as “Part D,” is a subsidized benefit that is provided by the federal government to Medicare participants. Due to the potentially high cost of prescription drugs, Part D is intended to make such prescriptions much more affordable for individuals who may be on a fixed income or have limited financial resources. The challenge is that some of these programs can be a bit difficult to understand, particularly as it pertains to rules and regulations.

Enrollment rules and guidelines. Consumers can get access to prescription drug coverage either by adding it to an existing Medicare plan or by enrolling in a package such as a Medicare Advantage Plan. These are typically provided by insurance companies and are specifically approved by Medicare. As noted on Medicare.gov, the official U.S. government website for Medicare, most consumers can take advantage of an enrollment period. The enrollment period for 2012, for example, was Oct. 15-Dec. 7, 2011.

Different costs of the program. It is difficult for consumers to estimate exact prescription costs, simply because a number of factors contribute to the overall expense. Consumers may be required to pay monthly premiums, and they may also have varied costs depending on the chosen program and the specific cost of individual prescriptions. Purchasing generic prescription drugs can lower the cost significantly.

Navigating the coverage gap. Another factor in the cost of drugs for Part D is the "coverage gap.” Essentially, some individuals may have a temporary limit on what the program will cover for prescription drug costs. This does not impact everyone, as a certain threshold of cost must be met before this applies. Once this gap is reached, consumers may be eligible for discounts on their particular prescriptions. In general, the U.S. government provides a wide variety of resources so that consumers can navigate the complexities of Part D.