Medicare Part D - Overview

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 2023 NYS plans). A more in-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 2023 plans which show the most recent plan closings and changes.

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

View Recorded Webinar 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 to 2023 updated figures not in the Outline:  

• Chart of 2023 Part D costs  - from National Council on Aging
• 2021 Extra Help copays in NYLAG PowerPoint slide 25
• See the NYLAG PowerPoint for other updated information

ALSO SEE

• 2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric Hausman, sponsored by NYS Office of the Aging

• See:

• 2023 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   .

• See Medicare Rights Center chart on 2022 Extra Help Income and Asset Limits 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.

• 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.