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Medicare Prescription Drug Coverage (Medicare Part D)

How to Find a Prescription Drug Plan | Key Dates  | Protect Yourself Against Fraud | File a Complaint | Helpful Publications | For More Information

The Medicare annual open enrollment period is October 15 through December 7.

How Does Medicare Prescription Drug Coverage Work?   

Medicare prescription drug coverage (Medicare Part D) pays some of the costs for prescription drugs at participating pharmacies in your area. Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses. The program is voluntary and can be especially helpful for people who have high drug costs and no drug coverage.

You usually pay a monthly premium, which varies by plan, and you may pay a yearly deductible. You will also have additional costs for your prescriptions. These additional costs are called copays or coinsurance, depending on the plan you select.

Medicare sets standard costs for the prescription drug benefit each year. Private companies approved by Medicare offer plans with different costs and selections of prescription drugs. You can select a plan based on the prescriptions you take and select a company that is most effective for you. To reduce your costs, enter your medications on Medicare's secure online Find health and drug plans website. You will pay more if your prescriptions are not in the plan formulary or the plan restricts or limits their use.

The donut hole: Once your annual drug costs exceed $2,850 in 2014, you will pay 47.5 percent of your covered brand-name prescription drug costs and 72 percent of your covered generic drug costs. In the coverage gap, you will receive a 50 percent manufacturer's discount on brand-name drugs. (There will be additional savings for you in the coverage gap each year through 2020 when you will have 75 percent coverage in the gap.)

The chart below lists the amounts you'll pay depending on the cost of your prescriptions in 2014:
If your annual drug costs are: 0-$310 $311-$2,850 $2,850-$4,550 Over $4,550
You will pay each year
  • Monthly premium
  • Your drug costs until they exceed the annual deductible of $0-$310, depending on your plan
  • Monthly premium
  • Copay or coinsurance on your drug costs from $311-$2,850
  • Monthly premium
  • 47.5 percent of your covered brand-name prescription drug costs and 72 percent of your covered generic drug costs exceeding $2,850 and until your annual drug costs exceed $4,550 (this is the coverage gap or "donut hole")
  • Monthly premium
  • A small copayment or coinsurance for each prescription after your costs exceed $4,550

* Your monthly premium will vary according to the plan you choose. Premiums range from $15 to $108 per month. In general, plans with higher premiums offer more benefits, such as coverage during the gap or no deductible. You may be able to qualify for low-income subsidies to help you pay your monthly premium.

How to Find a Prescription Drug Plan   

There is no single Medicare drug plan. To get coverage, you must enroll in a Medicare-approved private drug plan. There are at least two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage plan with prescription drug coverage. To learn more about Medicare Advantage plans, read the Texas Department of Insurance (TDI) Medicare Advantage Plans publication.

  • Visit the Medicare Prescription Drug Plan Finder to find a Medicare prescription drug plan in your area. You may either search for plans by entering your Medicare claim number and other personal information or by entering only your ZIP code. Providing your personal information will ensure you receive the most accurate results for the new Medicare drug benefit, how it applies to you, and how much you will pay.
  • Call 1-800 Medicare (1-800-633-4227) to get help searching for a plan. Have a list of medications and your Medicare card ready before calling.
  • Contact your local Area Agency on Aging (AAA) at 1-800-252-9240 for assistance understanding Medicare prescription drug coverage.

Key Dates   

Medicare beneficiaries who were eligible but have not enrolled in a drug plan can enroll during annual enrollment periods at the end of each year. If you were eligible and did not enroll before the deadline, you will have to pay a financial penalty. The annual Open Enrollment Period for Medicare Part D and Medicare Advantage plans is October 15 through December 7 of each year. Coverage begins January 1.

Individuals newly eligible for Medicare don’t need to wait for the next annual enrollment period to enroll in a drug plan. You can enroll during your seven-month initial enrollment period that begins three months before the month you're eligible and ends three months after the month you're eligible.

If you are enrolled in a Medicare prescription drug plan that leaves Medicare, you will have to select a new plan to maintain your prescription drug coverage. You must enroll in a new plan between October 15 and December 7.

If you currently have a Medicare prescription drug plan, the plan will notify you in the fall of each year about its changes for the coming year. It is important to ensure the plan you have still covers your prescriptions and at the best prices.

If you lose "creditable drug coverage" under certain situations, you may qualify to enroll in a Medicare drug plan within 63 days of losing coverage. Upon learning that you will lose prescription coverage, contact Medicare to learn what rights you have to pick up a Medicare prescription plan.

Helpful Publications and Resources   

TDI publishes the following publications to help you better understand your options and any available assistance:

Other resources:

Protect Yourself Against Fraud   

Companies approved to offer the Medicare prescription drug benefit can only contract with state licensed agents to sell their plans. Agents are required to follow state and federal laws when selling these plans. Ask agents to show proof of their license and verify the information by calling TDI's Consumer Help Line at 1-800-252-3439.

If you believe you've been the victim of fraud or attempted fraud, report it to TDI. Call the toll-free Consumer Help Line at 1-800-252-3439.

File a Complaint   

If you have a complaint against an agent or company selling Medicare Part D coverage, first file a complaint with the Medicare drug plan.

If you suspect agent misconduct or insurance fraud, file a complaint online with TDI.

For More Information   

Call the Medicare toll-free help line, 24 hours a day, seven days a week

1-800-Medicare (1-800-633-4227)
1-877-486-2048 (TTY)

View frequently asked questions on Medicare's website.

View Medicare and You. This handbook publication includes a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare.

Contact your local Area Agency on Aging (AAA). Benefits counselors can help you understand Medicare prescription drug coverage and assist you with other insurance issues. Call the Texas Department of Aging and Disability Services or visit its website

1-800-252-9240
www.dads.state.tx.us


For more information contact:



Last updated: 07/08/2014



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