Training materials written and updated by various staff at the Evelyn Frank Legal Resources program since 2005. This outline, updated for the 2016 Part D enrollment period, which is from Oct. 15, 2015 - Dec. 7, 2015, 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.
See 2016 Plan lists (Part D, Medicare Advantage)
Medicare Rights Center Special Enrollment Period (SEP) chart - when you may change plans outside of the annual enrollment period
CMS Guide to Mailings to Consumers about Part D and Extra Help- what the different colors of mailings mean; has hyperlinks to sample forms and notices. Also see CMS Reassignment Info .
This PowerPoint presentation was used in Selfhelp's training sessions (2014).
See Medicare Rights Center chart showing drugs covered by Parts B and D.
CMS Fact Sheet on TROOP. (what expenses count toward the deductible and "doughnut hole")
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.