Part D (prescription drug coverage) is voluntary and the costs are paid for by both the beneficiary and Medicare. Unlike Part B where beneficiaries must opt out if they do not want coverage, with Part D they have to opt in by filling out a form and enrolling in an approved plan.
Beneficiaries can get a Medicare-approved drug discount card if:
- They have either Medicare Part A or B
- Beneficiaries may not have outpatient prescription drug benefits through Medicaid or other sources.
- Beneficiaries may be enrolled in a state pharmacy assistance program (other than Medicaid)
Donut Hole
There has been lots of talk about the Medicare "Donut Hole," but what is it and how is the Affordable Care Act (ACA) going to affect our patients? Medicare Part D has an initial coverage limit and a catastrophic-coverage threshold under Part D. The donut hole, or coverage gap, lies between these two limits. Once a Medicare beneficiary uses up their initial coverage it is their responsibility to pay the full cost of their prescription drugs out of pocket until they reach the catastrophic-coverage threshold.