CMS Medicare

Officials at the Centers for Medicare & Medicaid Services note that Medicare Part D subsidizes the cost of prescription drugs for individuals on Medicare.

The annual enrollment period is Nov. 15 through May 15. There are more than 1,800 Medicare Part D plans available nationwide. The plans cover different types of drugs and have various co-payment amounts associated with them. CMS Medicare officilals note that help is availble in comparing Part D drug plans and costs with the Prescription Drug Plan Finder. Individuals can input prescribed drugs and preferred pharmacies and the Plan Finder can provide the total annual cost, monthly premiums and drug prices.

CMS Medicare notes that in 2008, most plans had no deductible and used a tiered system of co-payments. Standarized benefits required a $275 deductible from plan members. The plan member then paid 25 percent of prescription drugs up to $2,510.
Beyond the initial coverage limit for Part D, CMS Medicare points out, there is a coverage gap which must be picked up by the plan member. The plan member must pay 100 percent of the cost of drugs until reaching $4,350, at which time catastrophic coverage begins. Once under catastrophic coverage, plan holders pay $2.25 for generic drugs and $5.65 for other drugs.

The $4,350 out-of-pocket cost before reaching catastrophic coverage is calculated on an annual basis.

In 2007, CMS Medicare notes, 26 percent of Medicare Part D enrollees reached the coverage gap. And of those plan holders, 15 percent reached the catastrophic coverage level.

There is gap coverage available, CMS Medicare states, but those premiums are double those of standard benefits. Subsidees are available for low-income individuals.

Altough covering most drugs, Part D does not cover drugs not approved by the Food and Drug Administration and drugs available under other Medicare coverage, such as parts A and B. Other drugs not covered under Part D include: prescription vitamins, except prenatal vitamins; drugs for weight loss; treatments for erectile dysfunction; drugs for coughs and colds; and fertility drugs.

Most Part D plans have tiers, with various co-payments at each level. The biggest difference between most Part D plans is the coverage of name-brand drugs.

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