Living with Diabetes

Medicare Part D

• Medicare Part D is the prescription drug program available to all Medicare beneficiaries. Under Part D, you will have a variety of coverage options to help you pay for your prescriptions. Each Part D drug plan is run by a private company, and they will all look a little different from each other but they must all meet standards set by the federal government.
• Part D coverage is optional and you are not required to sign up for it. If you chose not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty if you decide to sign up in the future.
• In addition to providing prescription drug coverage, Medicare Part D ensures coverage for supplies necessary to inject insulin, including syringes, needles, alcohol swabs, and gauze.

How much does it cost?

• Most Medicare drug plans charge a monthly premium that varies by plan (separate from the Part B premium you may already be paying), plus some out-of-pocket expenses for your medications. Some drug plans also have a deductible.
• Most Medicare drug plans have a coverage gap (also called a donut hole). This means after you and your drug plan have spent a certain amount of money, you are responsible for paying all of the costs out of pocket up to a yearly limit. In 2010, if you have Medicare prescription drug coverage and have to pay for your drugs in the coverage gap, you will get a one-time tax free $250 rebate check from Medicare to help pay for your prescriptions.
• Starting in 2011, if you have high prescription drug costs that put you in the coverage gap, you will get a 50% discount on covered brand-name drugs while you are in the coverage gap. Additional savings will occur each year for people in the coverage gap through 2020, when the gap will effectively be closed.

Choosing a plan requires a little homework before enrolling. Here are some things you can do to help you decide:

• Every fall, Medicare will mail you the Medicare & You handbook, containing information about Part D plans available in your area. If you do not receive this booklet, contact Medicare at 1-800-MEDICARE (1-800-633-4227).
• If you think you might want to enroll in a Part D plan, start by making a list of the medications you currently take, including their names, your dosage, how much it costs each time you fill the prescription, and how often you fill the prescription. If Medicare does not consider your current coverage to be "creditable coverage," you will need to decide whether to keep it and risk having to pay a late enrollment penalty later if you decide to join Part D, or to cancel it and enroll in Part D now.
• Compare Part D plans to see how well they will serve your needs. You may wish to make a chart for yourself comparing the monthly premium, deductible, copay amount, and coinsurance percentage for all of the plans you are interested in. Make sure that the plan formularies include all of the drugs you take, and that the pharmacies you like to use are included in the plan network.