Training materials written and updated by various staff at the Evelyn Frank Legal Resources program since 2005. This outline, updated for the 2019 Part D enrollment period, which is from Oct. 15, 2018 - Dec. 7, 2018, 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.
NYLAG Evelyn Frank Legal Resources Program Medicare Part D Training Outline - 2019
BIG CHANGE FOR 2019: Medicaid recipients and others with Extra Help subsidy 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.
See Medicare Rights Center chart on 2018 Extra Help Income and Asset Limits (check back for 2019 chart)
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..
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.