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Medicare: Part D

Medicare Part D Prescription Drug Benefits were phased in by the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MIMA), 42 U.S.C.A. 1395w-101 et seq. Starting in 2004, Medicare-Approved Drug Discount Cards became available to all Medicare enrollees. The card did not pay the cost of prescription drugs, but reduced the amount paid for medications by 10 to 20 percent. Cards expired with the implementation of Medicare’s permanent prescription drug program in 2006.

Enrollment in Medicare Part D began in November 2005 and was scheduled to end on May 15, 2006 (although the program was available for use on January 1, 2006). Penalty for late enrollees is one percent per month of the Part D premium charged by the prescription drug plan ultimately chosen. 42 U.S.C.A. section 1395w-101 Section 1860D-13(b).

All those enrolled in Medicare are eligible to enroll for Part D benefits. Enrollees must choose a prescrip-tion drug plan offered by a number of Pharmacy Benefit Managers (PBMs) that best fits their health profile and anticipated prescription drug use. Monthly benefit premiums are approximately $35 (as of 2006). Enrollees pay a $250 deductible, after which Part D benefits begin. Part D benefits will pay 75 percent of prescription drug costs between $250 and $2,250. Enrollees then pay 100 percent of costs above $2,250 up to a maximum of $3,600 in out-of-pocket spending. Part D will again pay approximately 95 percent of costs above $3,600. Those drugs for which payment could be made under Medicare Part A are excluded from Part D coverage. 42 U.S.C.A. 1395w-102(e)(1).


Inside Medicare: Part D