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Medicare Part D - Overview

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Posted: 10 Nov, 2008
by David Silva (New York Legal Assistance Group)
Updated: 23 Oct, 2020
by Valerie Bogart (New York Legal Assistance Group)

The Evelyn Frank Legal Resources program has these resources for counseling Medicare beneficiaries and assisting them in accessing prescription drugs through the Medicare Part D program. 

NYLAG Recorded Webinar and PowerPoint presentation on Medicare Part D for the 2021 Year (for open enrollment from 10/15/20 - 12/7/20)

Gives updated information on Plan and benefit changes in NYS (see article on 2021 NYS plans).  A more ind-depth discussion is in the Training Outline below.  Note that the outline below has not been updated since the 2019 plan year.  Some changes should be noted, which are in this PowerPoint presentation.  However the outline is still current on the basic landscape and features of Part D. 

PowerPoint shows which plans are closing in NYS in 2021 and what consumer rights are when plans close.   Also see lists of 2021 plans

Note that a few slides were added to the above PowerPoint that were not in the webinar..  

View  RecordedWebinar Medicare Enrollment Issues for 2021 by Center for Medicare Advocacy about 2021 Part D and Medicare Advantage Changes..  Last part of webinar is a demo to show changes in the CMS PlanFinder

NYLAG Evelyn Frank Legal Resources Program Medicare Part D Training Outline - 2019 - 

This outline, updated for the 2019 Part D enrollment period,  covers the basic design of the Medicare Part D prescription drug benefit, the Extra Help subsidy for low income beneficiaries, how Part D works with other types of drug coverage including EPIC and Medicaid, and how to get Extra Help by using the Medicare Savings Program.  The Outline includes information on how the "donut hole" or coverage gap is being gradually closed so that out-of-pocket expenses during this period will be reduced, for individuals whose drug costs are so high that they fall into the donut hole. 

BIG CHANGE for Medicaid recipients and others with Extra Help subsidy - Since 2019, they may no longer may change plans every month.  They may change plans once per quarter in the 1st three calendar quarters.  See more about this and other "Special Enrollment Periods" or SEPS in the Outline at pp. 42 - 46. 

Note 2021 updated figures not in the Outline:  

ALSO SEE

  • See Medicare Rights Center chart on 2020 Extra Help Income and Asset Limits  (check back for 2021 chart)  and see 2021 Extra Help copays in NYLAG PowerPoint slide 25

  • See Medicare Rights Center chart showing drugs covered by Parts B and D.

  • Transition Policy - In this March 25, 2010 Memo, CMS reminded all Part D plans that they must have a "transition policy," under which they must provide a temporary supply of a non-formulary drug to new enrollees for a specified period of time, allowing them time to either request an exception from the formulary or to work with their physician to switch to a drug on the plan's formulary.   The memo includes a summary of all transition policies for different types of beneficiaries.   Transition policies are also explained on this Medicare Interactive. article and in this NSCLC article..

  • Information on the LI-NET program - for people who have both Medicaid and Medicare but are not yet enrolled in a Part D plan - used mainly for Medicare beneficiaries who are new to Medicaid, and have not yet been assigned to a Part D plan.   

The above outlines describe the Part D program and how it works in New York -- how it works with New York Medicaid, EPIC, ADAP, Medigap, and other programs.  For more national materials on Medicare Part D and other Medicare topics, see the Medicare Rights Center website and its Medicare Interactive website.


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG

Attached files
item Part D Outline 2019 FINAL 10-5-18.pdf (1.5 mb) Download
item MemoTransition_03 25 10.pdf (174 kb) Download
item NYLAG CLE PPT Part D 2021 AEP -REVISED.pdf (594 kb) Download

Also read
item Medigap (Medicare Supplemental) Policies and Rates in New York State - with Rate Tables for the Current Year
item EPIC - New York's prescription drug program for seniors age 65+
item Pathways to Extra Help - the Part D low income subsidy and how it can help your clients
item The Medicare planfinder tool: get (almost) all the info you'll ever need to help you pick the best possible prescription drug plan
item 2021 Medicare Part D Plans in NYS
item 2020 Medicare Part D Plans in NYS

Also listed in
folder Medicare Part D -> Extra Help
folder Medicare Part D -> Exceptions and Appeals
folder Medicare Part D -> Selecting a drug plan
folder Medicare Part D -> Getting Started
folder Medicare Part D -> Overview

External links
http://www.wnylc.com/health/client/images/icons/article_out.svg http://www.medicareinteractive.org/page2.php?topic=counselor&page=Index

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What drugs are covered?       2021 Medicare Part D Plans in NYS


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