Medicare Part D

Medicare Coverage for Prescription Drugs

Since January 1, 2006, Medicare has been offering insurance coverage for prescription drugs through Medicare prescription drug plans. Insurance companies and other private companies work with Medicare to offer these plans. These plans will help you save money on your prescription drug costs. Medical practice has come to rely more and more on new drug therapies to treat chronic conditions.

In order to get this prescription coverage, you must choose and enroll in a Medicare prescription drug plan that meets your needs. Here's how you can prepare to take advantage of this option

  • Look over your current health insurance coverage. Are prescription drugs covered? What are your out-of-pocket drug costs?
  • Keep a list of the name, dosage, and cost of the prescriptions you use. Since different plans will cover different drugs, this will help you choose a plan that meets your prescription needs.
  • If you have a limited income, you may contact the Social Security Administration (SSA) for an application to get extra help paying for a Medicare prescription drug plan. When you get this application, fill it out, and return it. Millions of people will qualify for a Medicare prescription drug plan with little or no premiums or deductibles, and low copayments. You might be one of them.
  • If you have prescription drug coverage through a former employer or union, check with your benefits administrator. Medicare prescription drug coverage may be different for you
  • Read on to learn about Medicare prescription drug plans

If you don't use a lot of prescription drugs now, you still should consider joining. As we age, most people need prescription drugs to stay healthy. If you do not enroll in Medicare Part D or another plan with creditable coverage (as good as Medicare’s), you may have to pay a late enrollment penalty in addition to your premium for Medicare Part D coverage in the future.

Best Available Evidence (BAE)

The Centers for Medicare and Medicaid Services (CMS) specify the requirements of a Part D sponsor in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary’s correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.

To address these situations, CMS created the Best Available Evidence (BAE) Policy in 2006.