Medicare Basics Part D

Horizons in Hemophilia, December 2011

By Robert Gillespie, LCSW, Social Worker

Since the beginning of Medicare in the 1960’s the use of prescription drugs has increased significantly.  As a result of increased use and cost of prescription drugs, Medicare recipients began mounting pressure on legislators to include a prescription drug option under Medicare.   In 2003 Medicare was overhauled by Congress.  This overhaul included Medicare Part D, which is also known as the prescription drug benefit. 

To be eligible for Medicare Part D, an individual must be eligible for Medicare Parts A & B.  Like Medicare Part B, Part D is voluntary and additional out-of-pocket expenses may be charged for the benefit.  Individuals selecting Medicare Part D can choose from two basic options: electing prescription drug plans (PDPs) or choosing a Medicare Advantage Plan (also known as Medicare Part C). 

The PDPs are stand-alone programs and do not require the purchaser to lump their Medicare benefits into a single plan, but allow the consumer to choose which plan best meets the needs of the individual.  Medicare Advantage plans often work like traditional insurance with the prescription benefit being rolled into the service provided by the company.  To help reduce costs, both PDPs and Medicare Advantage programs use drug formularies, which are approved lists of medications.

As this series of articles points out, Medicare is complicated even to those who work in the health care system.  The information in this series is meant to provide a basic understanding of how Medicare and each of its parts works.  Please be sure to contact your HoG social worker if you have questions about Medicare or Medicaid.

Read Medicare Basics from the October newsletter

Read Medicare Basics Parts B & C from the November newsletter.