Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual Medicare enrollment period because the features of Part D might have changed.
Mrs. Geisler can’t remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?
a. Part D covers hospital and home health services and the cost-sharing has changed this year.
b. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed.
c. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up.
d. Part D covers long-term care services, and she should not worry because there has been no change in coverage.
The correct answer to explain Part D to Mrs. Geisler is:
b. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed.
Here’s an explanation of why this is the correct answer and what you could tell Mrs. Geisler:
- What Part D is: Medicare Part D is the prescription drug coverage component of Medicare. It’s designed to help beneficiaries pay for their prescription medications.
- Why she should review her options: It’s a good idea to review Part D options annually because plan features, costs, and drug coverage can change from year to year. These changes might affect how much Mrs. Geisler pays for her medications or whether her specific drugs are covered.
- What to look for when reviewing:
- Premiums: The monthly cost of the plan
- Formulary: The list of drugs covered by the plan
- Cost-sharing: This includes deductibles, copayments, and coinsurance for drugs
- Pharmacy network: Which pharmacies she can use with the plan
- Coverage rules: Such as prior authorization or step therapy requirements
- When to review: The Annual Enrollment Period (AEP) typically runs from October 15 to December 7 each year. This is when Mrs. Geisler can compare plans and make changes if needed.
- Why the other options are incorrect:
- Option (a) describes Part A (hospital insurance), not Part D
- Option (c) describes Part B (medical insurance), not Part D
- Option (d) is incorrect as Part D does not cover long-term care services
By reviewing her Part D options during the annual enrollment period, Mrs. Geisler can ensure she has the most suitable and cost-effective prescription drug coverage for her needs.
