What is Medicare Part D?

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Medicare Part D is Medicare’s prescription drug program. Under Part D, private companies offer prescription drug coverage to people on Medicare.

Who is eligible for Medicare Part D?

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Anyone who is eligible for Medicare is automatically eligible for Medicare Part D Prescription Drug Coverage. This includes people aged 65 or older, Social Security Disability Insurance (SSDI) and Childhood Disability Benefits (CDB) beneficiaries, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

Do I have to enroll in a private plan to get Medicare Part D coverage?

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Yes. You must enroll in either a Stand Alone Prescription Drug Plan or a Medicare Advantage (Part C) plan with prescription drug coverage to get Medicare Part D Prescription Drug Coverage.

What prescriptions are covered under Medicare Part D Prescription Drug Coverage?

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Part D Prescription Drug Coverage plans must cover the majority of antidepressants, antipsychotics, anticonvulsants, antiretrovirals (HIV drugs), immunosuppressants, and antineoplastics (cancer drugs).

Part D plans generally do not cover over-the-counter drugs, barbiturates, benzodiazepines including diazepam (Valium) and alprazolam (Xanax), non-prescription drugs, weight regulation drugs, or hair loss drugs.

In most cases, Part D plans will not help pay for drugs that are covered under Medicare Parts A and B.

Do I have to pay for any of the costs associated with my Part D prescription drug coverage?

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Unless you qualify for the Low Income Subsidy (also called “Extra Help”), you will have to pay a premium, deductible, and copayments under Part D.

How do I know what my costs will be?

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You have to check with your specific plan for details. Medicare has created guidelines for what it calls a Basic Plan. Each company offering Part D Prescription Drug Coverage has to offer at least one plan that either meets the basic plan guidelines or works out to costing the same amount of money. For details, see Medicare Part D: Cost.

How can I get help paying my Part D expenses?

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If you qualify, you can get help paying for your Part D Prescription Drug Coverage expenses through the Low Income Subsidy. See Help Paying for Part D: Low Income Subsidy for more details.

Are there special rules about the Low Income Subsidy for people on both Medicare and Medi-Cal?

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Yes. The Low Income Subsidy is automatically available to people on Medicare and Medi-Cal (except for Medically Needy Medi-Cal). People on both Medicare and Medi-Cal are also automatically signed up for a Part D Prescription Drug Coverage plan.

How do I apply for the Low Income Subsidy?

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Some people are automatically signed up for the Low Income Subsidy. If you need to apply for it, you can fill out the online application or apply at your county social services agency.

Does Social Security count all my income when I apply for the Low Income Subsidy?

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No. Social Security has summaries of income and assets that don’t count. The Low Income Subsidy income limits are based on the Federal Poverty Level (FPL) and change in April of each year.

What if I don’t qualify for the Low Income Subsidy and Part D is too expensive for me? Do I have to enroll?

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No. Medicare Part D Prescription Drug Coverage is voluntary, so you don’t have to sign up for it. You can be on Parts A and B and still decline Part D coverage. If you do not have creditable prescription drug coverage, a premium penalty will apply if you decide to enroll at a later date.

How do I sign up for a Part D plan?

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Once you choose a plan, you can sign up on the Medicare website, by calling 1-800-633-4227, or by contacting the plan directly. If you are receiving Medi-Cal, you will be automatically enrolled in a plan.

What if my plan doesn’t cover a drug I need or stops covering a drug I need?

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The Part D Prescription Drug Coverage plans can change the drugs that are on their formularies as long as they give 60 days’ notice. There are a number of things you can do if this situation arises. See Part D: Getting the Drugs You Need for details.