What Is Medicare Part D and What Options Apply?

Tens of millions of American seniors rely on Medicare to help pay for their health care needs.

As long as someone is age 65 or older, a U.S. citizen or permanent resident living in the country for at least five straight years, and either they or their spouse paid Medicare taxes during their working years, they’re eligible for Medicare. The program offers government-funded health care coverage in a variety of areas, such as hospital care and outpatient medical services.

Another area of coverage is for prescription drugs. This is what’s known as Medicare Part D.

For most of its history, the Medicare program did not offer a prescription drug benefit. But that changed in 2006, when a bipartisan Congress added the coverage.

By 2017, more than 42 million Medicare beneficiaries had prescription drug coverage through Medicare Part D, which is optional. About 60 percent had a stand-alone prescription drug plan in conjunction with Original Medicare, also known as Medicare Part A (hospital insurance) and Part B (outpatient medical services). The other 40 percent had a Medicare Advantage prescription drug plan.

Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare as it allows program beneficiaries to receive their Medicare benefits through a private health insurance plan. Most Medicare Advantage plans include prescription drug coverage, although you may need to purchase a stand-alone drug plan if your specific Medicare Advantage plan doesn’t include prescription drugs.

For those enrolled in Original Medicare, the only source of prescription drug plans is through private insurance companies because Medicare A and B do not cover outpatient, or outside of a hospital, prescriptions. Medicare Part D, however, does pay for outpatient drug expenses. Each approved Part D plan covers different drugs and copays for covered drugs, which include both brand-name and generic products. It does not cover over-the-counter medications like cough syrups or antacids, prescription drugs like Viagra, or cosmetic treatments like hair growth elixirs or weight loss pills.

Here are several ways to get the Medicare Part D enrollment process started:

Call 1-800-MEDICARE to locate prescription drug plans in your area.
Log on to Medicare’s Prescription Drug Plan Enrollment Center.
Fill out the paperwork sent by mail from Medicare.
Call the private insurer with the specific prescription drug plan you want to join.
Call MedicareResources.org at 1-855-593-5633 and talk with a licensed agent.

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