Part D (Prescription Drug Coverage)
Part D is a voluntary outpatient prescription drug benefit that is delivered through private health plans contracting with Medicare. All Medicare beneficiaries are eligible for Part D, and may choose and join a Medicare Part D plan. Costs and coverage for different plans and specific drugs vary, so it is important for patients to evaluate plan options in light of their prescription needs when selecting a plan. Patients can learn more about Part D options and enroll in a plan at www.medicare.gov.
| 2012 Part D Patient Expenses1 | ||
| Premium | Deductible | Coinsurance |
|---|---|---|
|
Varies by plan and income National base beneficiary premium is $31.082 |
Varies by plan $0 to $320 per year |
Varies by plan
Patient pays a copayment or coinsurance (usually 25%) until $2,930 total in drug costs (including deductible) Once the patient and the plan have spent $2,930 for covered drugs, they are in the coverage gap and they must pay out of pocket for their drugs In 2012, the patient gets a 50% discount on covered brand-name prescription drugs that counts as out of pocket spending3 The coverage gap ends once the patient has spent $4,700 out of pocket for the year They would now have a nominal copayment through the end of year3 |
1. Centers for Medicare & Medicaid Services. Announcement of Calendar Year (CY)
2012 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment
Policies and Final Call Letter. April 4, 2011.
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/Announcement2012final2.pdf.
Accessed November 30, 2011.
2. Centers for Medicare and Medicaid Services.Annual Release of Part D National Bid Amount and other Part C & D Bid Related Information. Baltimore, MD: US Dept of Health and Human Services, Office of the Actuary; August 2011.
3. Centers for Medicare & Medicaid Services. Medicare & You 2011. Baltimore, MD: US Dept of Health and Human Services; January 2011. CMS Publication No. 10050.
