Resources for Understanding Medicare Part
As the nation's leading
provider of pharmacy services to the elderly, Omnicare is committed
to providing our customers and with the latest information about
Medicare programs. Omnicare is proud to support the facilities and
residents we serve with Medicare Part D assistance in a manner that
is both compliant and cost-effective.
The Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, commonly referred to as Medicare Part D, gave Medicare
beneficiaries access to prescription drug
The Medicare Part D Benefit Description,
information regarding Eligiblity & Enrollment, and Helpful
Links to additional online content regarding Medicare Part D can be
found on this page.
+ Show All -
+ Benefit Description
The Medicare Part D program provides prescription drug benefits
through one of two sources: (1) Medicare Prescription Drug Plans
(PDP) or (2) a managed care plan with a drug benefit (i.e.,
Medicare Advantage (MA)). The MMA defines a standard benefit design
for Medicare Part D, which is subject to variation by Part D plans.
For this defined standard coverage, most beneficiaries will pay a
monthly premium, estimated to be $53.99 in 2011, an annual
deductible of $310, and 25% co-insurance for costs above the
deductible up to the initial limit, which was $2,840 in 2011. Once
the initial coverage limit is reached, the enrollee must pay all
drug costs until the enrollee has $3,607.50 in out-of-pocket
expenses for covered drugs, which equates to $6,447.50 in total
The gap between $2,840 and $6,447.50 is being called the "coverage
gap" or "doughnut hole." After a beneficiary has spent $3,607.50 in
out-of-pocket expenses, catastrophic coverage begins and the
Medicare Part D plan will pick up approximately 95% of future
costs. Plans can offer a different benefit that is equal to or
"actuarially equivalent" to this standard coverage and plans can
also offer an enhanced benefit design (that might include coverage
in the doughnut hole or no deductible) for an additional
To help low-income individuals afford the prescription drug
benefit, the MMA provides for extra help in paying for premiums,
deductibles, and co-pays through the coverage gap and in
catastrophic coverage. Please visit the government's website to get
information regarding Low Income Subsidy.
+ Eligibility & Enrollment
To be eligible to participate in Medicare's prescription drug
benefit, individuals must be enrolled in or entitled to receive
benefits from Medicare Part A or B. Enrollment in Medicare Part D
plans is voluntary (except for dual eligibles). The enrollment
period for Part D prescription drug benefit runs annually from
October 15 through December 7. During this same period, individuals
may also switch or drop Medicare drug plans.
When an individual first becomes eligible for Medicare, they are
able to enroll during the seven month period that begins three
months before the month they turn 65, includes the month in which
the individual turns 65, and ends three months after the month in
which they turn 65. In the case of an individual receiving Medicare
due to a disability, they are able to enroll during the seven month
period that begins three months prior to the 25th month of
disability, includes the 25th month of disability, and ends three
months after the 25th month of disability. In some cases, people
with Medicare Part D can change to another PDP or MA-PD plan
outside the annual enrollment period.
To learn more about Special Enrollment, please visit the
government's Medicare website.
+ Helpful Links
Below are links to useful information about Medicare Part D
available on the web.
- The "Access to Benefits
Coalition" site to provide Part D information and benefits for
those with limited income and resources
- To help Medicare
beneficiaries get assistance with what plans are best for them
(decision support and enrollment service)
Kaiser Family Foundation has a variety of resource information
related to the Medicare drug benefit.