When you have chronic kidney disease (CKD) and require dialysis, there are many prescribed medicines you have to take. But prescriptions can be costly. In association with Medicare Part A and B, Medicare Part D became part of the Medicare reform signed into law in December 2003. Medicare Part D – formally known as the Medicare Prescription Drug, Improvement and Modernization Act – is a prescription drug insurance that is for people who have Medicare Part A, Part B or both.
People who can receive Medicare Part D are those who have enrolled in Medicare Part A, Part B or both because of:
You are not required to get Medicare Part D if you have creditable coverage with a commercial insurance plan (such as workman’s compensation). Creditable coverage is health insurance that can be used to make up for a preexisting condition exclusion period. Be sure to verify that your prescription coverage is regarded as creditable.
Double-check your commercial insurance plan if you decide to get Medicare Part D. Make sure your commercial coverage does not put your Medicare Part D plan at risk of being terminated. Ask your insurance agent or human resources representative for guidance if you decide to get Part D.
If you qualify for Medicare Part D and would like to enroll, there are several ways to go about it.
Medicare Part D prescription drug coverage is accessible through Medicare-approved private insurers. There are two plans you can choose from:
Here is a look at how much Medicare Part D may cost people on dialysis:
If you have a low income or minimal resources to pay for Medicare Part D prescription drug plan, you can apply for help. “Extra Help” is a program through the Social Security Administration to help people reduce out-of-pocket expenses for medication when they have Medicare Part D. Here are some other ways you can qualify for Extra Help.
If you automatically qualify for Extra Help, Medicare will enroll you in a Medicare Part D plan and you will be sent a yellow or green letter letting you know when your coverage begins. You may change plans at any time if you are part of this Extra Help program.
If you believe you have been overlooked and do qualify for Extra Help, you can apply online at www.socialsecurity.gov or call 1-800-772-1213. You can also ask your social worker at the dialysis center to help you with any questions about Extra Help.
As someone with end stage renal disease, you need to take prescription drugs that may be costly. If so, you will enter a coverage gap, also known as a “donut hole”, in your Medicare Part D coverage. This is where you will be responsible for 100% of the cost of your medicines for a period of time.
This “gap” in coverage generally begins at $2,830 in total drug costs (the amount that has been paid by you and the insurance company for prescriptions up to this point) and lasts until you spend $4,550 out-of-pocket (this amount includes your initial deductible, initial co-insurance/co-pay amounts and the full amount that you paid through the coverage gap.). Once you have spent the out-of-pocket maximum, your Medicare Part D plan will become “catastrophic coverage” and will pay for your drugs at a higher rate with you being responsible for minimal co-pay or co-insurance from that point until the end of the calendar year.
Here are some terms you may hear when you start Medicare Part D. This may help you understand what Medicare Part D entails.
Your social worker can help you with questions you may have about Medicare Part D. Social workers at the dialysis center are trained to be experts in answering your insurance questions. Whether you want to enroll for this coverage, need help filling out paperwork or if you have any issues with the insurance plan, the social worker is available to assist you.
When you have end stage renal disease, you will likely need many prescribed medications to help treat kidney disease. Medicare Part D is a prescription drug insurance that you may be eligible for if you already have Medicare Part A, Part B or both. Talk with your social worker about applying for Medicare Part D.
This site is for informational purposes only and is not intended to be a substitute for medical advice from a physician.
Please check with a physician if you need a diagnosis and/or for treatments as well as information regarding your specific condition. If you are experiencing urgent medical conditions, call 9-1-1