This federal outpatient prescription drug benefit, which began in 2006, applies to all Medicare beneficiaries, including those who are dually eligible for both Medicare and Medicaid. The benefit is administered through private prescription drug plans (PDPs) that meet Medicare guidelines for the program. People with Medicare select which of the plans being offered in their region best meets their needs.
Financial assistance is available to people with limited incomes. Dual eligible beneficiaries will pay no premiums as long as they stay with a low-premium plan, but are still required to pay co-pays. Other low-income people may apply for a low income subsidy through an application at their local Social Security Office (or online) or state Medical Assistance Office.
Almost all beneficiaries, including dual eligibles, will have some form of co-pay for each prescription. The co-pays will vary by plan. Pharmacies are permitted to waive the co-pay but, unlike under Medicaid, are not required to do so if an individual is unable to pay.
For complete information about the Medicare Part D Prescription Drug Plan, visit the official Medicare.gov website Medicare Prescription Part D Drug Coverage.
KFF Issue Brief: “Medicare Part D Spending Trends: Understanding Key Drivers and the Role of Competition”