Medicare Part D: Difference between revisions
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==Who is eligible for coverage== | ==Who is eligible for coverage== | ||
Anyone with [[Medicare]] Part A or [[Medicare]] Part B is eligible for Part D. | Anyone with [[Medicare]] Part A or [[Medicare]] Part B is eligible for Part D. | ||
There is a penalty for patients who delay their enrollment. This is designed to prevent patients from intentionally delaying their enrollment till just before changes in their health increase their drug costs.<ref name="pmid16382057">Kravitz RL, Chang S. [http://content.nejm.org/cgi/content/full/353/26/2735 Promise and perils for patients and physicians]. N Engl J Med. 2005 Dec 29;353(26):2735-9. PMID 16382057</ref> The penalty is an increase in monthly premiums by 1 percent for each month of delay after Medicare Part D went into effect on May 15, 2006. | |||
==Components== | ==Components== | ||
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* Medicare Prescription Drug Plans (PDP). These plans only cover the costs of prescription drugs and are for patients who use the Original Medicare Plan (e.g. Parts A and B) that provides [[fee-for-service plan|fee-for-service]] coverage of their health care costs. | * Medicare Prescription Drug Plans (PDP). These plans only cover the costs of prescription drugs and are for patients who use the Original Medicare Plan (e.g. Parts A and B) that provides [[fee-for-service plan|fee-for-service]] coverage of their health care costs. | ||
* Medicare Health Plans. These comprehensive plans cover the costs of both health care and prescription drugs. There are two types of Medicare Health Plans. | * Medicare Health Plans. These comprehensive plans cover the costs of both health care and prescription drugs. There are two types of Medicare Health Plans. | ||
** Medicare Advantage Plans (Medicare Part C). These plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). In addition, these plans may include Private Fee-For-Service (PFFS) Plans, Medicare Medical Savings Account (MSA) Plans, or Medicare Special Needs Plans (SNP). | ** Medicare Advantage Plans ([[Medicare Part C]]). These plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). In addition, these plans may include Private Fee-For-Service (PFFS) Plans, Medicare Medical Savings Account (MSA) Plans, or Medicare Special Needs Plans (SNP). | ||
** "Other" types of Medicare Health Plans such as Medicare Cost Plans, Medicare demonstrations or pilot programs, or PACE (Programs of All-inclusive Care for the Elderly). | ** "Other" types of Medicare Health Plans such as Medicare Cost Plans, Medicare demonstrations or pilot programs, or PACE (Programs of All-inclusive Care for the Elderly). | ||
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==Criticisms== | ==Criticisms== | ||
Medicare Part D has been criticized for its "Byzantine complexity"<ref>Cooper HA. [http://content.nejm.org/cgi/content/full/354/18/1960 Medicare drug benefit]. N Engl J Med. 2006 May 4;354(18):1960-1; author reply 1960-1. PMID 16672714</ref> and "doughnut hole" coverage | Medicare Part D has been criticized for its "Byzantine complexity"<ref name="pmid16672714">Cooper HA. [http://content.nejm.org/cgi/content/full/354/18/1960 Medicare drug benefit]. N Engl J Med. 2006 May 4;354(18):1960-1; author reply 1960-1. PMID 16672714</ref> and "doughnut hole" coverage<ref name="pmid16382057">Kravitz RL, Chang S. [http://content.nejm.org/cgi/content/full/353/26/2735 Promise and perils for patients and physicians]. N Engl J Med. 2005 Dec 29;353(26):2735-9. PMID 16382057</ref>. | ||
==History== | ==History== | ||
Medicare Part D was enacted as the Medicare Prescription Drug, Improvement and Modernization Act of 2003."<ref name="MedicarePartD">{{MeSH}}</ref> Coverage provided by the plan began January 1, 2006. | Medicare Part D was enacted as the Medicare Prescription Drug, Improvement and Modernization Act of 2003."<ref name="MedicarePartD">{{MeSH}}</ref> Coverage provided by the plan began January 1, 2006. | ||
==External links== | |||
Medicare website: | |||
* [http://www.medicare.gov/pdphome.asp Prescription Drug Coverage] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 17:21, 6 October 2009
In the United States of America, Medicare Part D is a "stand-alone drug plan offered by insurers and other private companies to beneficiaries that receive their Medicare Part A and/or B benefits through the Original Medicare Plan."[1][2]
Who is eligible for coverage
Anyone with Medicare Part A or Medicare Part B is eligible for Part D.
There is a penalty for patients who delay their enrollment. This is designed to prevent patients from intentionally delaying their enrollment till just before changes in their health increase their drug costs.[3] The penalty is an increase in monthly premiums by 1 percent for each month of delay after Medicare Part D went into effect on May 15, 2006.
Components
There are two different, but separate, plans by which a patient may obtain Medicare Part D coverage:[4]
- Medicare Prescription Drug Plans (PDP). These plans only cover the costs of prescription drugs and are for patients who use the Original Medicare Plan (e.g. Parts A and B) that provides fee-for-service coverage of their health care costs.
- Medicare Health Plans. These comprehensive plans cover the costs of both health care and prescription drugs. There are two types of Medicare Health Plans.
- Medicare Advantage Plans (Medicare Part C). These plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). In addition, these plans may include Private Fee-For-Service (PFFS) Plans, Medicare Medical Savings Account (MSA) Plans, or Medicare Special Needs Plans (SNP).
- "Other" types of Medicare Health Plans such as Medicare Cost Plans, Medicare demonstrations or pilot programs, or PACE (Programs of All-inclusive Care for the Elderly).
Enrollees may switch plans during the open yearly enrollment period which November 15 through December 31 of every year.
Criticisms
Medicare Part D has been criticized for its "Byzantine complexity"[5] and "doughnut hole" coverage[3].
History
Medicare Part D was enacted as the Medicare Prescription Drug, Improvement and Modernization Act of 2003."[1] Coverage provided by the plan began January 1, 2006.
External links
Medicare website:
References
- ↑ 1.0 1.1 Anonymous (2024), Medicare Part D (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Bach PB, McClellan MB. A prescription for a modern Medicare program. N Engl J Med. 2005 Dec 29;353(26):2733-5. PMID 16382056
- ↑ 3.0 3.1 Kravitz RL, Chang S. Promise and perils for patients and physicians. N Engl J Med. 2005 Dec 29;353(26):2735-9. PMID 16382057
- ↑ Centers for Medicare & Medicaid Services. Prescription Drug Coverage
- ↑ Cooper HA. Medicare drug benefit. N Engl J Med. 2006 May 4;354(18):1960-1; author reply 1960-1. PMID 16672714