Medicare Part D Notice - Terms & Conditions

By: Lewis Mark
Published: Wednesday, October 10 2018
Last Updated: 4 years ago

There are a couple of reasons you are receiving a Medicare Part D Notice. Let's look at why you are receiving the notice and what the notice means for you. The notice you receive is intended to provide you with the information you need to make an educated decision about your prescription drug coverage. Because of the Medicare prescription drug, improvement and modernization act, the Medicare Part D program was implemented. Medicare Part D is the insurance program for prescription drug coverage available through Medicare. As someone who is eligible for Medicare Part D, you have a choice in the drug coverage you receive.

Medicare Prescription Drug, Improvement and Modernization Act

The Medicare prescription drug, and modernization act, also called the MMA, made several changes to Medicare plans. These new changes affected prescription drug coverage. Now formularies can be used to limit prescription drug options available to beneficiaries. Prescription coverage can be conceded to the patient. It can also be submitted to a Medicare Part D prescription plan.

Many Medicare Advantage plans offer Medicare Part D. You can also enroll in a Part D plan sold by an insurance company. A plan that you enroll in through an insurance company is used with Original Medicare. Before signing up for Part D, read the details of the plan to make sure you understand what your benefits will be. Medicare Part D is a voluntary prescription drug benefit. It is only available through insurance companies and health maintenance organizations.

Medicare Part D Notice

The MMA requires insurance companies, that have policies with prescription drug coverage, to notify eligible policyholders whether their prescription drug coverage is considered creditable or non-creditable coverage. Creditable coverage means that their prescription drug plan provides coverage that is expected to pay as much as a Medicare prescription drug plan. Simply put, if your insurance plan has drug coverage, then they must tell you if their coverage is equal to, or less than, the coverage available through Medicare.

Coverage Notices Requirements

The first requirement states that companies must provide a written disclosure notice to all eligible individuals. This is required so you can make an informed decision, during Medicare Part D open enrollment, about enrolling in a Medicare Part D prescription drug plan. The second requirement says that insurance companies must complete the Online Disclosure to CMS Form. This form is to report the creditable coverage status of their prescription drug plan.

Who Receives The Notices?

The Medicare Part D notice must be sent to everyone that is enrolled in or applied for an insurance policy with prescription drug coverage, and are qualified for Medicare Part D coverage. If you are actively working, a retired individual, or are disabled, you should receive a letter. This also applies to COBRA members and their dependents. If you are not covered by creditable prescription drug coverage, you should obtain prescription drug coverage during Medicare Part D open enrollment. If you do not enroll during Medicare Part D open enrollment, you may be required to pay higher premiums when you do choose to enroll in Medicare Part D.

Model Notice Letters

Understanding your options can be confusing. You can find model notice letters online. However, the model notice letters may be modified by insurance companies before they are sent to you, so don't be surprised if yours looks a little different. Whether your drug coverage is creditable or non-creditable, you should still receive a notice letter. You should keep your notice letter, because you may need to submit it when you join a Medicare plan.

When considering if you should enroll in Part D, evaluate the coverage you have, and compare it to the coverage you would receive with Part D. Medicare Part D pays for outpatient prescription drugs and some self-injected medicines, like insulin. Part D does not pay for over-the-counter medications or certain prescription medications, like prescription vitamins. The expense of Part D depends on many factors. You should compare premiums, copays, annual deductibles, coinsurance and coverage gaps before making your decision.