Medicare Part D History

The history of the Part D plan started with discussions about adding prescription drug coverage to the Medicare program. Up to this time, the plan had been fraught with federal deficit discussions and other interests to get you started in the plan.

There was divided conflict centered around a prescription drug program run by private health care companies or expanding its present coverage for Medicare members, low-income, and middle-income families. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was a good beginning, but it did not wholly encompass benefits that many thought the Medicare prescription drug program should identify.

Going back a little further in Medicare history, the continual discord around prescription drug benefits was discussed by former Richard M. Nixon and Lyndon B. Johnson’s administrations. Under the Medicare Catastrophic Coverage Act of President Bill Clinton, prescription drug plan benefits have been enacted and then through various revisions have been repealed. It wasn’t until the last term of President Clinton did the Medicare prescription drug plan resemble what we experience today.

Historically, Medicare Part D announced its eligibility to almost 44 million Medicare beneficiaries, to both the insurance and health care industry:

*December 2003 – the Medicare Part D benefit was enacted

*January 2005 – the CMS finalized its final regulations

*May 2005 – the Social Security Administration sent out its federal notices announcing Medicare Part D prescription drug benefit based on co-pays, with additional assistance for low-income individuals and families

*October 2005 – the CMS sent a description bulletin to Medicare members succinctly outlining the benefits of the Part D program.

Part D Coverage

The Medicare Part D plans are today’s insurance coverage for prescription drugs. The Centers for Medicare and Medicaid Services (“CMS”) sponsors the Medicare Part D prescription drug program. Under the direction of the CMS, private insurance carriers are responsible for implementing the varied Medicare Part D plan across the U.S.

Medicare Part D, or PDP (the prescription drug plan), is responsible for prescription drug coverage for Medicare members. Each Medicare PDP has a list of formulary drugs that are covered by each plan. The Medicare prescription drug plan pays a portion of prescription drug costs and whatever healthcare plan that interests you to get started. Whom you have chosen as a co-payor will pay the rest.

Part D Components

Before the year 2006 and under Medicare Part B, Medicare only paid for certain drugs requested by a hospital or a private physician’s office for their patients. Then at the beginning of 2006, Part D benefits became authorized by Congress under the Medicare Prescription Drug, Improvement, and Modernization Act (“MMA”) of 2003 which was signed into law by former President George W. Bush. Part D under the MMA is known as “Medicare Rx.”) Medicare Rx enables Medicare members to pay for outpatient prescription drugs.

Interestingly, the Medicare Part D prescription drug plan is the only Medicare benefit that is not administered by the government. Part D is a privately sponsored benefits that Medicare has contracts with private healthcare companies who sell Part D insurance coverage. Yes, insurance carriers are subsidized by Medicare under their enrollment requirements.

The Medicare prescription drug program is available as a prescription-only program or a Medicare Advantage plan that includes healthcare and prescription drug coverage. Depending on the healthcare plan you have chosen as your primary insurance coverage, Medicare beneficiaries will pay a monthly premium under the separate Medicare Part D plan. But if you choose the Medicare Advantage plan, our premiums are zero.

What Does The Future Hold?

Today some Medicare prescription drug plans feature a coverage gap. This means that after a Medicare member has used a certain amount of money, then they are in a gap, or a commonly called prescription drug gap, known as the “donut hole,” for using brand-name drugs. The generic and brand-name drugs will feature a discount coverage gap until it ends in 2019 from its original end date of 2020. The future of Medicare Part D prescription drugs is experiencing the following:

*premiums are decreasing

*the donut hole under The Affordable Care Act is ending for brand-name and generic drugs. Brand name drugs will only cost Medicare members 25% of the plan’s cost which is down from 100% through the Affordable Care Act.

*maximum allowable deductibles will increase

Under the Trump Administration’s American Health Care Act enactment, there is a continued discussion of whether the donut hole should continue to be closed. Some agree that the donut hole should remain intact and others believe that closing the donut hole is better for healthcare reform. The Medicare Prescription Part D government discussions continue!