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Medicare Part D - Medicare Prescription Drug Coverage

Medicare Prescription Drug Plans are approved by Medicare and designed to cover your outpatient and maintenance prescription drugs. It enhances your Original Medicare and/or Medicare Supplement Insurance Plan. Even if you don’t take any prescription drugs, consider enrolling in a prescription drug plan when you become eligible. You want to protect your health and finances and be covered if your situation changes.

How Medicare Prescription Drug Coverage Works

Medicare Part D helps you pay for your prescription drugs. Because Part D is a government program, the Centers for Medicare and Medicaid Services (CMS) closely oversee every aspect of the program. Every detail, from the drug list (also called the formulary) to how an insurance company sells its plans, is reviewed and approved by CMS.

Before an insurance company can sell Medicare Part D coverage, it must have its proposed benefits, premiums and the drug list approved by CMS. This makes sure the coverage follows federal guidelines and it protects you as a Medicare beneficiary.

Medicare Part D Eligibility

If you answer “yes” to at least one of the following questions, you may be eligible.

  • Are you age 65 or older and have Social Security or Railroad Retirement Board benefits?
  • Are you under age 65 with certain disabilities?
  • Do you have ALS (amyotrophic lateral sclerosis) or, at any age, End-Stage Renal Disease?
  • Have you or your spouse worked for at least 10 years in Medicare-covered employment?
The Four Phases of Part D Prescription Drug Plans

All Part D plans, have the phases below. Benefits offered within the plans can vary.

  • Annual Deductible: You pay this amount for your prescriptions before the private insurance company you choose begins to pay.
  • Initial Coverage: You pay a copay or coinsurance for each eligible prescription filled.
  • Coverage Gap: You pay your prescription drug costs until you reach a year-to-date True Out-Of-Pocket (TrOOP) cost (payments including deductibles, copays, coinsurance). During this time, you may be eligible for a discount on brand name drugs and a discount on generic drugs at the time of purchase.
  • Catastrophic Coverage: You pay a copay for generics, a copay or coinsurance (whichever is greater) for other drugs, and coinsurance for specialty drugs after TrOOP costs are reached.

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Medicare Advantage Plan Notice:
HMO plans provided by GHS Health Maintenance Organization, Inc. d/b/a BlueLincs HMO (BlueLincs). HMO and PPO employer/union group plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). HCSC and BlueLincs are Independent Licensees of the Blue Cross and Blue Shield Association. HCSC and BlueLincs are Medicare Advantage organizations with a Medicare contract. Enrollment in HCSC’s and BlueLincs’ plans depends on contract renewal.

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross and Blue Shield of Oklahoma members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Medicare Part D Plan Notice:
Prescription drug plans provided by Blue Cross and Blue Shield of Oklahoma, which refers to HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plans depends on contract renewal.

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Last updated 08/24/2020