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This section addresses Medicare Part D, the part of Medicare that covers most outpatient prescription drugs either through a stand-alone Part D plan or included in a Medicare Advantage Plan. You will learn how each Part D plan covers different drugs on its formulary, take a closer look at the drugs Part D and Part B cover, and find out which drugs are excluded from Medicare coverage. The section also details the cost structure of Part D plans, particularly the way premiums, deductibles, and copay/coinsurance amounts can vary, depending on the plan. We provide detailed explanations and examples to illustrate the four different phases of Part D coverage in any given calendar year: the deductible phase, the initial coverage period, the donut hole or coverage gap, and catastrophic coverage. We will also explore common coverage restrictions, including prior authorization, quantity limits, and step therapy. Finally, we’ll introduce Medicare Plan Finder, an online tool that helps individuals compare and find a Part D plan that works for them.
After taking this section, you will be able to:
- Identify which types of drugs Part D does and does not cover
- Understand Part D costs and coverage throughout the year
- Explain coverage restrictions that Part D plans can place on covered drugs
- Use Plan Finder to choose a drug plan
- Interactive activities and knowledge quizzes
- Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
- Educational content vetted by a team of national experts at Medicare Rights Center
- Closed captioning
- An array of printable supplementary tools and fliers