A federal program that subsidizes the cost of prescription drugs for Medicare beneficiaries. It is an optional benefit that helps cover the cost of prescription medications, offered through private insurance plans approved by Medicare.
An individual who is eligible for and receives benefits under a health insurance plan, such as Medicare Part D. Beneficiaries may include seniors, individuals with disabilities, or those with certain chronic conditions.
A list of prescription drugs covered by a Medicare Part D plan. Each plan has its own formulary, which may vary in the medications it covers and the associated costs.
The monthly fee paid by Medicare beneficiaries to enroll in a Medicare Part D plan. Premiums vary depending on the specific plan chosen and other factors such as income.
The initial amount that Medicare beneficiaries must pay out-of-pocket for prescription drugs before their Medicare Part D coverage begins to pay. Deductibles vary between plans and may change annually.
A fixed amount that Medicare beneficiaries must pay for each prescription drug they purchase, typically a percentage of the drug’s cost. Copayments vary depending on the tier of the drug within the plan’s formulary.
A temporary limit on what Medicare Part D plans will pay for prescription drugs. Once total drug costs reach a certain threshold, beneficiaries enter the coverage gap and are responsible for a higher percentage of drug costs until they reach catastrophic coverage.
After beneficiaries have spent a certain amount out-of-pocket for prescription drugs in a calendar year, they become eligible for catastrophic coverage. During this phase, Medicare Part D provides increased financial protection, and beneficiaries pay only a small coinsurance or copayment for covered drugs.
A service offered by some Medicare Part D plans to help beneficiaries optimize their medication regimens, improve medication adherence, and minimize drug-related problems. MTM services may include medication reviews, consultations with pharmacists, and personalized medication plans.
A program that helps Medicare beneficiaries with limited income and resources afford their Medicare Part D prescription drug costs. Extra Help may cover some or all of the premiums, deductibles, and copayments associated with Medicare Part D coverage.