The Medicare Prescription Drug Law: Is Part D Right for You?
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The changes to Medicare prescription coverage can be confusing to those who are already dealing with the rising costs of prescription drugs. The “Medicare Prescription Drug, Improvement, and Modernization Act of 2003,” will officially go into effect January 1, 2006. This gives precious little time to those that will be most affected by these changes.
Adam Welch, assistant professor of pharmacy at Wilkes University, says that the major part of the new law is the addition of a Part D component to Medicare. Part D is a voluntary prescription drug coverage that is run by private insurance companies that have to follow government regulations.
“With so many parts to Medicare, it can be very confusing to figure out which Parts are best for you,” says Welch.
Those over the age of 65 were eligible for Part A coverage of hospital expenses. Part B was optional and covered physician services. Part C gave optional coverage to fill in health care gaps. Now, the new coverage offered by Part D adds an additional factor to the equation.
Each plan may be slightly different depending on the provider. Medicare Part D will cost around $35 per month as a premium, and have a $250 deductible per year. There will be a 25 percent co-payment on total prescription cost.
“For example, if your medicine costs $100, you will have to pay $25 each time you get it filled,” says Welch. “However, once you spend $2250 in a year, there is a gap in the prescription coverage. Medicare will not cover any costs until you spend $5100 on prescriptions. Once that point is passed, prescriptions will cost 5 percent co-pay or $5 for brand, whichever is higher, with no limit on the co-pay.”
The Part D prescription plan was designed for people without drug coverage. If you have private prescription coverage, then you will probably not see a benefit from Part D. Also, if your prescription costs are less than $800 per year, you would not see a benefit because the deductible and premiums would cost more, according to Welch.
“Talk to your pharmacist or your insurance provider for information on whether or not Part D is right for you,” says Welch. “Remember the new Part D is optional. You do not have to enroll. If you decide to enroll late, however, there is a penalty.”
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